Resonance, Attunement, And Presence

An outdoor restaurant in summer: A young couple with two children, one about three, the other about four months. The mother nurses the baby, snuggled in her lap. For the longest time, the baby's face is buried in the breast and under parts of her mother's blouse. But her hand is playing with her mother's the whole time. Later, her head surfaces, and she sits on her mother's lap, gazing at her. The mother makes cooing noises, and tilts her head slightly. The baby opens her mouth, making a perfect circle, her blue eyes wide open too, drinking in her mother's face. Her eyes are so open, her mouth is so open, her face is so open, she is an incarnation in this moment of pure presence. The eyes are radiating presense. The mouth is quivering with presence.

The mother puts her head down and touches it to her baby's forehead, then moves it back. The baby smiles. There is a complete force field connecting these two. This baby is in the orbit of her mother in this moment, and the two are speaking in a thousand ways, on a thousand wavelengths, across their bodies where they touch, across the air between them.

...As her older sister sits at the table, I can feel that she too is at home in her body and in the force field of her family. It is not even that they interact that much. They don't. But they form an inseparable whole in which she is completely at home.
--Myla and Jon Kabat-Zinn, Everyday Blessings: The Inner Work of Mindful Parenting, page 189

There is an ideal of mothering* that assumes that babies are born one at a time. This isn't a medical ideal --although the medical ideal exists and is, in fact, more easily asserted, defended, and accepted -- but a psychological, even spiritual, ideal. It is an ideal of infancy, the elevation of an idea about what mother and baby create between themselves in the first hours, weeks, and months of a newborn life. It is the ideal of the singular gaze.

No mother, not even the mother of a first-born singleton, achieves the ideal. Colic, sleeplessness, hormones, employment, mealtime and laundry, they all conspire to muddy the flow between baby and mother, to fracture that heart-locking gaze across a thousand distractions. Yet the ideal exists and persists, not just as a weapon to bludgeon imperfect women but as a spiritual attainment that most mothers and babies approach and breathe upon, if only for fleeting seconds. It is this spiritual ideal of mothering, of infinite and boundless and all-encompassing love, that causes infertile women so much pain. It is this ideal that hovers out of reach as cycle follows cycle, paperwork confounds, and pain multiples over years.

For mothers of multiples, it can seem that the ideal becomes a thing forever out of reach. Just as the ideal, the madonna image, the vision of perfect oneness, hovered over our infertility, it goes right on hovering over our lives with multiple newborns. In every second spent holding one infant, drinking in one infant, falling in love with one infant, another infant waits, filled with the same longing for mother love, filling mother with the same longing for the singular gaze. The mother is always and forever divided, not between children with different needs and infinite varied desires, but between infants whose needs and desires coincide, overlap, entangle, and confuse. It is heart-wrenching. It causes physical pain.

Losing my chance for the ideal filled me with rage. My fury and my grief were boundless, the bitter apex of my infertility, the achievement of a vision forever tainted by what would never be. This was my theme and my refrain for months after the babies were born: look at the world we have lost. Look at what we will never have, and never be.

Other parents of multiples turned their backs on me in the moments I dared to confess my grief and my rage. I heard so many platitudes, so many dismissals, so many admonishments: How dare I feel grief when my babies were happy and whole? Don't you love your children? Think of the special bond they'll have among themselves.** The advantages will outweight the drawbacks, and don't you dare believe anything else. For God's sake, grow up and get over yourself.

Well, the children grew up, and I have mostly gotten over myself. But I refuse to believe that minimizing my pain helped me overcome it. Denying my loss didn't help me feel it less. When I held one baby at the breast, when I settled one baby close upon me, my eyes immediately sought another. The baby nearest me was the baby least in need of me in that moment, and my gaze was forever divided. I wrote that I held my babies enough, that I had enough time alone with each of them, but I lied. It was never, ever enough, and I forever felt divided. I see a friend with her newborn singleton and a tiny piece of my heart still aches.

What brings me comfort is this: the mothers of singletons, unlike the mothers of multiples, admit my loss. They know what they have, and they know the magnitude of not having it. The simple admission, "I can't imagine having to share this time with another baby," soothes my soul.

---

*I hate making nouns into verbs through gerends. I hate the term "mothering" especially. But it's the only word available that brings this particular experience of mine into sharp relief. I typically want to include Calder and use the word parent, but this ideal is an ideal by and of and for mothers, and I don't want that to be lost.

**Obviously my frame of reference is incomplete, but I don't believe that the bond between multiples is better than the bond between singletons. Undoubtedly it's different, but it's not better. For every mother of multiples who marvels at the laughing voices of her babies babbling to each other in their cribs, there's a mother of two singletons marvelling as her oldest child teaches her youngest child a new word. Is the delighted laugh of a baby discovering her twin any more delightful than that of a baby smiling back for the first time at his older sister? Special bonds between siblings are precious and delightful and I'm grateful not to face the pain and sorrow of secondary infertility, wanting as I did more than one child. But special bonds between siblings are more than, different than, bonds between mothers and infants, and one does not replace the other.

Audrey's Mom

Okay, I love this. It's so of-the-moment, it's practically tailor-written for a little piece in the New York Times. The Times, not Salon, because Salon is a little more aware of the how the internet works, and not so inclined to describe the normal in terms of fancy condescending psycho-sociology. What am I talking about? A woman I met at La Leche in Connecticut found my blog via Tertia. I made internet contact with someone I haven't spoken to in two years because I commented on a blog written by a South African woman. Come on, admit you think this is wild.

So, in case this episode doesn't make it painfully obvious, I'm not writing to disguise myself from those who've met me. I think it would take any of my friends or family or passing acquaintances about three seconds to figure out that this is my blog. For one thing, they would recognize the kids in the photo that accompanies my profile. For another, I'm using my real name. And for the last, I use WEG in the title, even though it has yet to appear in the text, and WEG is a dead giveaway in my circle.

No, I'm not pursuing total anonymity. With a little deductive logic and a little internet investigation, I'm reasonably certain all of you could find me in two or three searches. No, I'm disguising the names and precise current locations and other extraneous details mostly to keep myself flying below the google radar. I don't want anyone to find this website while looking for me. Oh, also, I don't want my kids' future prom dates to learn all these intimate details about their lives. HAHAHAHAHA.* Ahem. No. I'm disguising the kids' names in particular because they haven't given consent to use them, and because I'm still not quite certain how the internet aids or abets child abduction (most of which is done by folks the child and the parents would describe as known), and because it just seems like the right thing to do. Everyone has to go with their gut on this one, and this is my gut: don't use the kids' names. Don't announce their exact birthdates. Don't post identifying photos. Don't give people enough information to lead them to your door, at least not without e-mail exchange.

Some of my wariness about the photos arises from imaginary triplet families. There have been a few websites and forum identities created with the use of borrowed photos of triplets. (Apparently this happens to parents of singletons, too.) I have more of a "whatever" attitude to imaginary online identities than many people, but I'm not going to let someone else claim my kids. I suppose the trade-off might be that the lack of explicit details (especially on the Triplet Connection) might lead some folks to doubt me. An especially paranoid survivor of the TC might even suspect I invented Erika, Audrey, and Isabel, just to lend myself some credence.

I know that people being hired in my once and future employment field should expect to be googled. I would prefer that my blog habits not be part of the results. I don't suppose being a semi-literate mom to many would count against me, but it doesn't need to be part of the hiring profile. (If you google my real name, you'll find an article about Calder and me and our kids in the archives of a certain university publication anyway.) Also, I don't want Calder or my mother or my mother-in-law to find this site by accident. Luckily, they're all indifferent to blogs, to a greater or lesser extent, and they're not that handy with internet search engines, so I'm not especially worried. Maybe I should be, though, now that Erika's found me. It is pretty wild.

But if you're out there lurking, not telling me you've found me because you're worried I'll be weirded out, well, I might be. But come on out and say hello anyway, because honestly, is anyone surprised? I'm so self-involved and chatty that I bombarded poor Erika with my birth story when she was, indeed, pregnant with Isabel. And really, what sort of egotist doesn't remember the first rule of vaguely menacing birth stories: don't inflict 'em on pregnant women!

[I'm trying to play that lightly, but the truth is, I went home from La Leche that day convinced that Erika thought I was a jerk. Then again, I worry that about most people I meet and talk to: convinced of my own public persona's likeability, I am not.]

*How many Mommy blogs have existed for as long as Dooce's? How many of them are hosted on Blogger or a another free site? How many of them are likely to exist two years from now, let alone six or ten or sixteen? Apparently the folks at the Times have never heard of the word ephemera.

Library Books

I signed the babies up for libary time in the fall of 2002. Calder's office was ten minutes from the downtown library, and he didn't lecture on Tuesday mornings, so he could come with me. We would park up by his office, load the babies into their enormous stroller, and walk down together. The librarians would read a few books, interspersed with simple finger plays and dances, and then they would haul out several buckets of toys or a big box of musical instruments for fifteen minutes of free play. At the same time we were doing the library outings, I was also taking parent-child swimming lessons with the babies, and going out to stores with the babies by myself a great deal more than previously, and taken all together, it was during that autumn that I regained my equilibrium. I started to feel normal.

Just after Christmas, Calder went away for a conference one week and I took the babies to the library by myself. I was scared to stay home and admit that I depended on someone else, and so even though I was also scared about the possibility of a toddler whirlwind, I went, and I managed just fine. The babies get a lot of the credit. I think I've mentioned that they are fairly low-keyed and even-tempered, and by then, they knew the routine and the people and how to behave. Also, although I never got to know the other families terribly well, we'd all gained enough rapport to lend a minimal amount of assistance to each other--it extended at least so far as to warn that a baby was breaking for the door. And the librarian knew us by then, and gave me the benefit of the doubt. I could have been irritated that I had to earn her trust, prove that we wouldn't be a disruption, but all I felt at the time was gratitude for everyone's good will.

Once I had proven that I could manage the library myself, Calder's attendance became more and more sporadic, and eventually he stopped going altogether. I had and have mixed emotions about that: I wanted to be normal, and certainly a mom with her kids at the library is the epitome of a certain kind of privileged normal. (Actually, in that particular group, I was abnormal--a bare majority of the adults were nannies.) At the same time I was getting an ego boost from my weekly forays into super-competency, though, I missed spending time as a family with Calder. I also resented the way he took advantage of my growing competence--most of which felt thrust upon me by sheer necessity, rather than conscious will--to withdraw from the intimate participation in the babies' lives that marked their first eighteen months. And it bothered me that Calder rarely seemed to praise or even notice my work with the babies, because out in the world, my quest to be normal meant I had to keep deflecting everyone else's praise.

All told, we did library time for about eighteen months. By late fall 2003, it was clear that the babies had outgrown the toys and that it wasn't worth the hassles of driving downtown. I signed them up for Kindermusik instead in the spring of 2004, after clearing it with the teacher that my good friend Beth, whose daughter is four months older than the kids, would also be attending and could offer me an extra set of hands. Beth was an insurance policy I never really needed to use. My kids rarely wanted to sit on Beth's lap, her daughter didn't want to share Mommy, so I learned how to tap eggs or twirl scarves in sequence. When we signed up for Kindermusik summer camp after our move, I told the new teacher we'd be fine, I offered to put her in touch with the old teacher if she needed reassurance (she didn't), and that was that. I'm done making special arrangements to put other people at ease.

Well, yes, now that the kids are four, most people aren't asking me to make special arrangements. But on principle, I won't do it anymore.

Most parents of multiples are turned away from toddler activites on the presumption that the class--library, Kindermusik, Gymboree, whatever--demands a 1:1 parent-child ratio. This tends to bother me quite a lot. Parents of multiples are already isolated enough without being deliberately excluded from most of the major gatherings of suburban Mommyland. Instead of the presumption being that parents of multiples can't handle it--as was my case, having to provide extra adults to set teachers at ease--I think there should be a presumption that we can. At the very least, I think parents of multiples should feel free to use backdoors into these events. Promise to bring a babysitter or a grandparent and then, once you've won over the group and the teacher, try coming by yourself once. It's certainly better than sitting at home.

One thing we didn't do at the library was borrow books. I needed to get our city's library card before the downtown system would issue me borrowing privileges, and I never took the time. (Our local library refused to sign us up for their toddler class because of the adult:child ratio problem.) One of the first things I did in our new town was drive over to the library and borrow some books. I actually meant to go to the toddler reading hour, but we were late out the door and I couldn't muster the courage to ask a stranger about the rules for late entry, so we picked some books off the shelf and I signed up for a card instead. Boy, was I stupid not to do this before. The kids love borrowing books. Yes, they wish they could keep some of the books,and we've borrowed quite a few twice now for that reason. But it's a great feeling to pull up the old Amazon wish list, print it out, and then borrow all those books from the library instead. Think of all the money I would have saved if I'd thought to borrow library books sooner!

Now that the kids are four, they get to sign up for their own library cards. Tomorrow is the first time we'll have visited since they've become eligible, I haven't told them about this new privilege, and I'll keep you posted on their reactions.

I have meant to write down the lists of books we've borrowed, but never gotten around to it. Now that I'm imagining this blog as more of a permanent record for the kids, I can just copy the list from the library's on-line system and post it here. So be forewarned: every three weeks or so, I'm going to post a boring list just like this:

• Arthur's Birthday by Marc Brown
• Arthur's New Puppy by Marc Brown
• Cinderella at the Ball by Margaret Hillert
• Cinderella: The Dog and Her Little Glass Slipper by Diane Goode
• One Fish Two Fish by Dr. Seuss
• The Too Hot Day by Beverly Komoda
• Owl Moon by Jane Yolen
• Rumpelstiltskin by Paul Galdone
• Swan Lake by Donna Diamond
• William and the Night Train by Mij Kelly

I should write about the kids' reactions, and why certain books were borrowed, it's the sort of information I'll tell myself now I couldn't possibly forget, but not remember six months from now. And yet--I'm not going to do it. Not tonight, at least.

The Spoiled, Unconsolable Baby Canard

We're headed into the final stretch of the AP FAQ here....

Were you worried they’d get spoiled, and too dependent on external comfort when they were sad?

No. I don’t think you can spoil a baby. I especially don’t think that parents of multiples can spoil their babies: we don’t have the time, the arms, or the energy. But more than that, it has gradually dawned on me that halting a workable solution today just because it might cause problems in the future is, well, insane. Just because I never imagined that the kids would still be wearing night-time diapers at age four, doesn’t mean I should have started potty training at age two. It was age appropriate to respond to every cry from a three-month old baby and to rock her to sleep every night. The babies at 26 months had very different needs and abilities, and now, at age four, I have no hesitation in walking my kids back to their beds, tucking them in, and saying good night again. The crucial factor for me was that my kids trust me to meet their needs. How else do you do that, except through responsiveness?

I also agree with the temperament researchers, who say that what works well for one child may not work at all for another, because of her inborn temperamental needs. Strict schedulers of multiples don’t seem to agree with that idea, at least not in my experience. There tends to be a lot of talk about "teaching the baby she’s not a singleton, and she doesn’t get to do that [particular inconvenient habit]." Gemma has always been a "good sleeper," at night at least, sleeping as much as six hours at a stretch at 2 months and falling asleep in the crib after being laid down awake at five months. Elba had a terrible time relaxing at the end of the day right from the beginning, a fact commented on by every single person who came to stay with us. Elba would actually lie stiffly in my arms as she nodded off, and if pushed too fast at bedtime (whether in crib or swing), she would throw up and become hysterical. Remarkably, by 26 months, she would kick me out of bed at night: she’d gently remind me "night-night, sweet dreams" and get Gemma and Wilder to play along. It was enormously satisfying to watch Elba make that transition, and to believe that I’d helped her along by meeting her need for rocking and parental soothing earlier on. Now, Elba’s the only one of the kids who almost never climbs into bed with me at night, almost always lies in bed awake after the others have dozed off (she still takes longer to unwind) but also sleeps a solid 45 minutes longer in the morning. It was so, so hard to meet Elba’s sleep needs sometimes in the first 18-24 months, hard not to want to just lay her down screaming and run far away, so seeing her so self-sufficient and happy in sleep is a fantastic feeling. Meanwhile, William falls asleep fast, wakes up early, and has virtually nothing in common with his sisters when it comes to sleep. I don’t think that’s at all surprising or unique: my brother and sister and I had fairly different sleep habits, too.

Did they learn to comfort themselves?

Yes. It definitely took longer because it was at their pace, not mine, but in ten years, I doubt I’m going to look back on their baby years and say, gosh, I wish I’d rocked, nursed, and cuddled them less. Right now, today, I miss those times. I needed down time, I absolutely needed Calder to come home and give me my breaks, but I’m not sorry I chose the route I did. I’ll never rock another baby again--I’m incredibly, unspeakably grateful that I did it once.

Plus, I suffered pretty severe post-partum depression. Practicing attachment parenting was incredibly healing for me. I actually didn’t fully embrace it until six or eight weeks after Elba came home; before then I spent a lot of energy and time trying fruitlessly to get the babies onto a schedule, and I was miserable. Were their days I melted down and just wanted the lives of my friends who propped bottles to stay on schedule, introduced cry-it-out at twelve weeks, and laid their babies down awake, thereby getting to see their favorite TV shows in real time? Oh, yes, yes, there were those days. But taken all in all, now that those days are past, I'm so glad I spent my time the way I did. Besides, my kids are enormously self-confident, secure, and happy. Whatever Calder and I managed to cobble together, I think it laid a nice, sturdy foundation.

Well, I know a family who practiced AP and their kid...

"...only slept in the parents’ bed at night, was still night-nursing continually at 15 months, her parents had no sex life, she needed two hours to fall asleep and then only if one or both parents lied down with her, she only napped if the mom slept too, never ate at meals, demanded snacks continually, and was a whiny, clingy, demanding brat by the time she was two"? Yes, I’ve heard of that family! They really get around, don’t they. They seems especially well-known to the baby nurses who post on the Triplet Connection, women who like to say they’ve never met a family for whom AP works, that they’re always being called in to help fix the poor deluded AP parents’ bad choices. I’ve always thought this was about as insightful as the personal trainer who claims he’s never met anyone who eats chocolate without developing a raging weight problem (hello—you’re a problem-solver, people only come to you when they have problems) but whatever.

My short-answer response to these stories is this: you can be a "bad" parent doing a lot of different things. There are "bad" AP parents and "bad" scheduling parents and "bad" whatever-the-hell-else parents. Parenting philosophies are guides, they offer tools, and how you use those tools doesn’t always reflect on the philosophy. Have you met the family who fed their kid formula (yee gads! oh no! how could they! ... Wait, we fed formula ... oh, never mind) on a strict-three hour schedule, left him to scream in his crib for an hour when he was 12 weeks old, and never held him because babies need to learn independence? And now he’s an allergy-ridden thug with an eating disorder and a bed-wetting habit? I think they live right next door to that out-of-control AP family you mentioned. Out on Bad-Mommmy-Myth Lane?

Karen Gromada wrote once on the APMultiples site that she tried to make choices based on a fairly simple formula: what was her child supposed to learn and accomplish during this particular life stage, and what were her goals for how her child would behave, believe, and feel as he entered the stages to come? I wrote at the beginning of this endless little discussion that my primary goal in the first year was to have a really tight mother-baby bond. Everything I did in the early months arose from that. I can easily imagine folks who had the same goal for their baby’s first year, who made completely different choices than mine. I can also imagine people whose goals were very different from mine, but whose choices were the same. It’s a complicated situation, raising a child, and I’ve found that I don’t often agree 100% with Calder about how to handle something, let alone anyone else. But enough with the "everyone I know who did that" stories about attachment parenting, because now you know me, and it’s just not true.

Multiple Attachments: Life Without a Schedule

There is no way you can you practice Attachment Parenting with multiples!

The crucial books for me were Mothering Multiples, rev. ed.; and Keys to Parenting Multiples, both by Karen Kerkhoff Gromada. Gromada is a long-time La Leche League leader, certified lactation consultant, and mom to twin boys who are now in their twenties, plus three other now-grown singletons. She believes that parents, not book authors, are the best experts on their children’s needs; that parents should provide responsive, loving care to their babies and children; and that the parent-child bond is central to all children’s emotional growth, whether the child was a multiple-birth baby or not. Although I read the Sears’ Baby Book, there were and are a great many Sears ideas I wasn’t able to implement fully, babywearing being the most obvious. Too often, I closed the Sears' books feeling guilty more than helped, so I learned to leave them alone. Also, I lost patience with their tendency to call parents who make different choices detached. What a crock.

In practical terms, I learned to spend a lot of time on the floor, cuddling one baby while stroking another’s body if they were fussy, and relied on swings and bouncers when my arms were full. I could nurse/rock one baby while gently bouncing two others in vibrating bouncers with my feet, and I kept my feet clean and bare to increase skin-to-skin contact. I tried using Snuglis and Baby Bjorns, but my back took a beating during the pregnancy and they weren’t very comfortable. When I discovered slings at about 14 months, I started wearing my toddlers more: I wish I’d discovered Kangaroo Korner and the Maya Wrap when the babies were tiny and still in the in-arms stage.

No, seriously, how did you feed three babies without a schedule?

For the first six months, I staggered the babies’ first feed of the day and then let each baby ask to eat after that, with a bit of nudging to keep them staggered as much as possible. On most days, that meant each baby got a half-hour block of time, so I would feed babies at 8am, 8:30am, and 9am, then at 11am, 11:30am, and 12pm. In theory, I mean. In practice, the babies would switch positions all over the place, because like I already wrote, Wilder wanted to eat every 2 to 3 hours while Gemma wanted to eat every 3 to 4 hours. And all of them wanted to eat more frequently as the day went on. And the babies who nursed wanted to eat sooner than the babies who got formula. And regardless of the clock, none of my babies seemed to have been equipped with internal chronometers, and some days were more hectic than others. I still vividly remember one nightmare day when for whatever reason, I was nursing one baby at the top of each hour from 8am until 7pm, when Calder came home and we did our daily group top-off feeding to trigger the nighttime, two-adults routine.

True confession: I had panic attacks in the early months. I could not tolerate the thought of two babies getting hungry and screaming to be fed at one time, and at first, I had no confidence that I could do anything to avoid that possibility. Throughout April and May 2001, there were many days when Calder would go on campus at 8:30am, give his lecture, pick up his mail, and be home by noon. I was so lucky that he had that kind of flexibility. Often, on a Friday, he would take one baby to work with him, too. That was marvelous and amazing—going from three babies to two was such a release. Calder also had a sabbatical from the university for the entire 2001-2002 academic year. I’m pretty sure that we couldn’t have been so flexible at home without his consistent presence at home. Even with that, though, he insisted we hire a mother’s helper in late April 2001, and until she had to leave in mid-June 2001 (her son was finished with school for the year), I was able to relax three mornings a week, knowing there was another pair of hands available to comfort crying babies. Also, she did laundry, washed the boxes of hand-me-down toys, and kept me company. If I could do it over again, I would have hired her earlier. I didn’t because I was sick to death of nurses hovering over me at the NICU and wanted to be home alone, must me and my husband and our babies. Competing interests collided.

If I could do it over again, besides making a whole host of different breastfeeding choices, I would have practiced modified demand feeding. Without getting into a convoluted explanation, you start by feeding one or two babies at a time, feed the remaining babies all in a row, then wait for the hungriest baby to demand food again, then rouse the other two and feed them. It takes some of the pressure off, and allows for the possibility that the babies will nap at roughly the same time. Ah well—I’m not going to go out and conceive triplets again just to prove to myself I can do it correctly this time.

For the first four or six months, we didn’t have terribly formal bedtimes. Calder and I would feed the babies downstairs while we watched television, then line them up in bouncers or on our laps and let them fall asleep. The babies would wake again anywhere between 9:30 and 10:30pm, we would do their last downstairs feed, and then take them up to bed. They slept all together in one crib in our bedroom for about two and a half months,* then in separate cribs in the nursery after that. Gemma went through a period in May and June 2001 when she refused to drink from a bottle, and Elba did the same thing in (I think) August and September. Wilder was on special formula and nursed once a day at most for most of the summer of 2001, but as the girls’ nursing tapered off, he increased his time at the breast until, by mid-November 2001, Wilder did nothing but breastfeed. Then, in a stirring testimony to the power of the breast, Wilder went on refusing milk in cups and bottles for another 18 months. He went from being a non-nursing infant to a non-stop nursing toddler.

By around six months, we formalized bedtimes. I would nurse one baby down in the glider in the nursery while Calder cuddled the other two downstairs in the living room, offering a bottle of formula if someone was especially fussy. Then, I would nurse another baby down while, most of the time, the third baby would fall asleep with DH. (Calder has fond memories of rocking Gemma down in his office while "The Dark Side of the Moon" played softly in the background.) As the babies fell asleep, we would lay them in their cribs. By around nine months, Wilder always went first for nursing: besides the fact that he was beginning to refuse all formula around then, he also fell asleep the fastest. It was the rarest of nights when he wasn’t lying limp and unconscious, a tiny dribble of breastmilk at the corner of his mouth, by the time "All the Pretty Little Horses" was playing on the stereo. Then I would nurse either Elba or Gemma, depending on who was fussier. It was, I’m sorry to say, pretty consistently Elba who rated second in my arms by Christmas, and I’m sure that’s why Gemma stopped nursing just before her first birthday. One night, she just didn’t want to be bothered taking the breast. I was heartbroken, and I still worry that it hurt our bond: she’s my child most likely to run hot and cold. And she’s been Calder’s favorite since birth, something that would bother me less if only Elba didn’t so obviously push every button he’s got. Troublesome, that, not just for Elba’s sake, but because she’s so much like me.

This bedtime routine was time- and labor-intensive. What also proved increasingly difficult was the co-sleeping I adopted in desperation as Wilder and Elba showed no signs of sleeping through the night: I kept on laying them down in their cribs at bedtime, but as they woke, I would bring them to bed with Calder and I. When Gemma started waking at night because of molar pain just after her first birthday, it all started to seem too overwhelming. Also, Calder started looking ahead to the end of his sabbatical year and realizing that he didn’t have too many more 60-90 minute bedtimes left in him. Everything converged such that, in May 2001, we removed the cribs from the nursery, laid a king-sized mattress on the floor, and at bedtime I began lying down with the babies until they fell asleep. I would lie on right side, Wilder would nurse my right breast (it was the only one that produced any sort of measurable milk at all by then), Elba would drape herself up my back and across my side and nurse my left breast, and Gemma would lay her head on my outstretched left hand. At first, I stayed in the room until everyone fell asleep. By the time the babies were 22 months, I would nurse for 10 to 15 minutes but leave the room with everyone still awake—although Wilder continued to collapse into sleep while nursing, and even now, he’s often asleep just seconds after saying good night, while the girls will lie in bed and chat for as long as half an hour. When someone woke up, I would return to the nursery, crawl onto the mattress in between them, and fall asleep nursing or cuddling. We switched to toddler beds in November 2003, and the routine has been a little unpredictable since then: sometimes I lie on the nursery floor until everyone’s asleep, sometimes Calder does, sometimes I say goodnight and leave.

As for that hallowed goal, Sleeping Through the Night: Gemma started sleeping 12 hours uninterrupted at about 10 months; she did six hours’ sleep as early as 2 months. Elba slept 12 hours at around 10 months too, but she would wake at 4am for a quick nursing session (or a bottle—what can I say, I was tired) until she was just about 15 months old. Wilder, alas, had rotten sleep habits—probably due to the reflux, although maybe it’s just Wilder’s personality, he’s still a very wakeful kid—and as late as 26 months, he would sleep only 10 hours at night, with one night-nurse at 1am and another at 5am as well. I thought I was in it for the long haul, but he gave up the 1am session and then the 5am session all in a rush, and started sleeping straight through at 29 months. It’s deeply strange how all-consuming the question of uninterrupted sleep felt at the time, and how long ago those sleepless nights now feel. (The kids are doing their part to remind me, though, by having vivid nightmares and crawling into bed at all hours in search of comfort. It seems as if most daytime stresses—moving, preschool, potty training—invariably show up at night.)

Naptime was a challenge. Until about 9 months, each baby had a separate but overlapping nap schedule because each had his or her own feeding routine. I vividly remember my surprise one afternoon in July 2001, during my friend Diane’s visit, when all three babies napped in their bouncers together for two whole hours. Normally, I never got that much down time. I confess, it wore on me: naptime was when I most wanted just to leave the babies in their cribs and walk away, crying be damned. Starting at around 9 months, after we’d introduced solids and the babies’ schedules overlapped so much more, I started planning and hoping for regular morning and afternoon naps, and I wasn’t shy about using swings to lull any resistors. Typically Wilder would nurse down quickly, as would Gemma if Elba didn’t scream her head off at being forced to wait to nurse (tandem nursing not being an option because I had only one productive breast), but the challenge was to get all three down for a nap with enough time left for me to breathe before the first woke up again. I can’t think of a single babycare book that offers even marginally useful advice about naptimes, and I can’t think of a single issue more likely to drive me around the bend than failing to get the babies to nap. (One good idea that didn’t work for us, but worked for a TC poster I adore, was to lay down with all three babies on the floor, nursing and cuddling until they fell asleep--and then sneak away.) At the babies’ one-year appointments, my pediatrician actually suggested what I’d already started doing: car naps. I would say from 10-14 months, the babies took at least 1 car nap a week -- they would sleep for 2 hours in the car. Meanwhile, starting at around 13 months, after Elba had outgrown the swing -- which had been her nap location of choice -- I switched everyone to cribs for naptime. If someone hadn’t fallen asleep within 10 minutes of nursing, I would lay her down awake in the crib, explaining what I was doing. Amazingly, Elba, who had depended so much on the swing, took to the crib without a peep, and immediately went from being my best napper but in the swing to the best napper in the crib. Wilder just went on being the breast man he was, needing his five or ten minutes to fall into a milk-induced haze, while Gemma mostly took to the crib but fussed for 5 or 10 minutes before settling. Because Gemma wasn’t nursing any more, the fact that she was the baby whose fussing I most often waited out caused me endless anxiety. I still imagine her reading my journals some day and saying, "ah ha, this is why I’ve always thought you loved me least." Arg.

By eighteen months or so, we didn’t need car naps anymore. The girls would nap in a crib and a pack-n-play in the master bedroom, while Wilder nursed down in the nursery. Between reliable 2.5-hour naps and the babies' increased mobility, the "two's" were an amazing, wonderful year for me. The kids gave up their naps entirely just after our move this past June, but no one had really been sleeping very well since their third birthday. Often, the girls would chat for an hour or more, then fall asleep and nap until 5pm, throwing bedtime into chaos, while Wilder (who stopped nursing at naps ... hmm, I don’t even remember when) would often have just laid in bed staring at the ceiling or reading a book, and of course would have a meltdown if we didn’t get him to bed at night as soon as possible. It was easier, finally, just to give up my dreams of a daytime break in return for earlier, easier bedtimes.

How were you able to hold them all enough?

For the first year, because of the staggered feeding schedule over the first nine months and then the stair-stepped naps (especially in the morning), I had a lot of one-on-one time with each baby. This was frankly one of the things that kept me going with attachment parenting when I had playdates with moms who propped bottles, laid everyone in cribs and shut the door. I didn’t have as much time for myself, Calder, or the house, but I had a lot more time with each baby alone. After the NICU, and in the context of multiples, that one-on-one time was precious to me.

*The whole beginning was such a blur, it wasn't until I wrote to Tertia about sleep habits that I remembered Calder and his mom putting the babies to sleep one night in their cribs in the nursery, and realized that we must have moved them there by mid-April. I was always making those mistakes back then, overestimating just how long a particular stage or phase had lasted. I just didn't realize those misimpressions would have such a long shelf life.

Coming Next: Answering the Critics

Defining My Terms

What do you mean, "Attachment Parenting"?

I believe the attachment, or bond, between baby and parent takes precedence over other concerns, particularly in the first nine to twelve months. (For the record: I do not believe Bill and Martha Sears when they write that working during your baby’s infancy makes you detached. What a load of crap.) I believe that parents need to respond to their babies’ cues, so that babies learn to trust their parents. I believe that establishing trustworthiness and a sense of safety is the first job of parenting. I believe that what a baby wants and what a baby needs are the same things in the first year. I believe that holding your baby as much as possible is a worthy ideal.

I believe that parenthood gets harder as your child gets older, because the child’s needs and wants start to diverge, and because parents are supposed to start gently pushing their child to expand his limits and his horizons and to take a chance. I believe that your toddler will let you know when he’s ready to fall asleep on his own, stop wearing diapers, and spend more time apart from you. I believe that parents should respect separation anxiety and stranger anxiety and not force their toddlers to stand apart too soon. I believe that children should be cooperative, not obedient. I believe that children raised to be cooperative are not, in school or on the playground, significantly distinguishable from children raised to be obedient.

For me, leaving a baby to cry for any length of time had too great a potential to damage the mother-baby bond. Having multiples exacerbated that fear, because I found that I had a very slow learning-curve of "cry recognition." It took me a very long time to learn three different sets of cries: for hunger, wet bottoms, loneliness, anger, or "leave me alone, I just need to fuss about the world." I didn’t trust myself to know which cries could be left alone: I wanted to respond to all of them.

In general, the people I know who practice cry-it-out and parent-directed scheduling tended to say and post things like "my baby was twelve weeks old, he weighed twelve pounds, all this waking to eat at night was habit, not need." I tended to believe my babies knew their appetites for food better than I did. The parent-directed scheduling folks would write that their multiple-birth babies who fussed so much didn’t really need to be held, they were just wanting extra attention. I was always thinking, if this little tiny baby could speak, what would she be saying? Do I think she's saying, "Mommy, Mommy, I need you to hold me," and if so, do I want to respond, "no, no, Mommy’s too busy, it’s time for bed, you’re really just fine," give her a pat, and leave her to cry? At six months, the answer was "not in a million years." At four years, the answer is, a lot more often than I would have predicted. But hey, my kids are four now. They are, for all intents and purposes, entirely different people than the ones I mothered in 2001.

It drives me crazy when Calder loses patience and walks away when I start crying, and I’m an adult. I would never walk away from a crying baby.

Coming Next: You can't do that with multiples!

Attachment Parenting and Me

It’s amusing, and a little sad, to think back to the day when the question of schedules and of letting the baby cry were the be-all, end-all issues of our parenting life. (I know that the question of mothers working operates very early too, but I’ve always thought that particular "debate" was insulting to everyone involved, so I’m going to give it a wide berth here.) Parents of preschoolers know from debatable issues: Disney Princess: adorable or nauseating? Television: harmless diversion or agent of Satan? If yes to TV, kid-friendly only, or "Fear Factor" and "WWE"? (Don’t scoff, the question of kids’ favorite TV programs arose not long ago on the Triplet Connection and several mothers said their 4-year old sons’ favorite programs were wrestling. Fear Factor is the #2 or #3 prime-time show for children ages 2-11.) Preschool: Waldorf, Montessori, or unschooling? Discipline: how do we keep these little balls of energy in line? The level of diversity in parenting simply explodes as kids get older, and puts all the sound and fury about baby bedtimes to shame. I’m convinced the only reason why the scheduling/crying issue gets so much press is because new parents are the only parents naïve enough to believe they might find definitive answers. Also, because they still have a little money and time left to buy and read parenting books. All I have the energy to do these days is ... well, watch mindless TV. But not Fear Factor or the WWE: my mindless television of choice tended to run toward all things Whedon, until his shows went off the air.

Maybe because I miss the days of easy answers, I thought I would throw out there that Calder and I practiced attachment parenting with the babies. We’re not rabid freaks about it, I couldn’t carry even one baby in a sling because of back problems and we’re not one of those families with three futon mattresses spread across our bedroom floor. But on the spectrum of approaches to parenthood, we were at the AP end of the line. I think this merits some explanation, not least because everyone always assumes that no one with multiples could possibly survive without a schedule. Schedules just don’t work for everyone, so hearing that one family managed just fine without them might be encouraging to someone, some day. Besides, I love a good debate.

So, here’s a little FAQ for you, adapted from a post I made to the Triplet Connection that’s now been deleted. I’ll post it in parts, because it’s mighty long. Please, please, keep in mind this important fact: Nothing I write here should in any way be construed as a criticism, veiled or otherwise, of your choices. It was just what worked, and made sense, for us.

Why Attachment Parenting?

Because what Bill and Martha Sears write about fussy babies made the most sense to Calder and me, and we weren’t on board with the idea of leaving babies to cry it out. Because I wanted to do everything possible to nourish my babies’ individualism, and I didn’t know how else they expressed themselves in the early months except through their particular, individual needs for sleep and food. Because I had a rough, rough relationship with my mom and wanted to lay a firm foundation of loving kindness and an aura of warm embraces between my babies and me, and lots of rocking, cuddling, and responsiveness seemed like the way do to that. Because I knew they’d been left to cry in the NICU and I couldn’t bear the thought that they’d be left alone at home, too. Because I so desperately desired one-on-one time with each baby that staggered schedules and completely independent naptimes worked well for me, taken all-in-all.

Oh yeah, also because I was really, exceedingly lazy. I read this fantastic book by T. Berry Brazelton called Touchpoints, and in every single new chapter, Brazelton would explain how to teach and re-teach your baby to sleep independently. Apparently, babies have immature sleep cycles—they "surface" more at the peak of each three-to-four hour cycle, it’s linked to the development of REM sleep—and every little thing can set them off. Babies who’ve learned to sleep through the night wake again when they start teething, when they learn to roll and crawl and stand and walk, when separation anxiety sets in, when dreams start, when they get more teeth….The list was endless, and at every "touchpoint," Brazelton explained that parents had to go into the nursery, give their child his lovey, pat him on the back, and re-teach him how to soothe himself. I’m sorry, but I didn’t have the time or the patience for that. It was far easier just to crawl into bed with the wakeful child and fall back asleep, okay?

There’s also a certain cult-like atmosphere around scheduling and high-order multiples. I never drank the Kool-aid, and I never quite understood the idea. Would anyone think it was natural for three babies born on the same day to different parents to eat, sleep, and be actively alert all at the same time, just because they share a birthday? Does anyone out there have two children born in different years whose infant habits were identical? Why should multiple-birth children somehow be more capable of synchronization than newborn neighbors or different-aged siblings? Why should three siblings behave identically in their eating and sleeping habits, just because they shared a uterus and a birthday?

Now, I’ll grant you, looking back, I can see that most babies are pretty malleable. I suspect most babies are just as happy to eat, sleep, and play in rhythm with their siblings as otherwise. In our particular case, it simply wasn’t workable: Wilder had reflux and needed small, frequent meals right up until the day he started solids. Gemma was two or three pounds heavier than him very early on, and could go four hours between feeds. These were babies whose needs simply were never going to be tweaked into conformity.

Coming Next: What is Attachment Parenting?

A Little Statistical Stuff

This has come up from time to time, on a whole variety of blogs (typically as a throw-away line about those wacky triplet folks, so undeserving of their media fame and so unethical with the inappropriate ART protocols--yes, I know I've gone there, too), so let's just get it out of the way: Not every triplet pregnancy resulted from infertility treatment. In fact, something like 1 in 10 triplet pregnancies is a surprise: no fertility treatments were involved. Needless to say, those pregnancies are a special kind of shock for the expectant parents. Imagine finding that out at 20 weeks. Hang out with enough mothers of triplets and you'll find out: it happens. Oof.

Here are some of the numbers: According to various sources, there's one spontaneous triplet pregnancy for every 6,000 to 8,000 pregnancies in this country. John Elliott proposes a ratio of 1 in 6,900 and from that, estimates that there are about 580 spontaneous triplet pregnancies a year. Mothers of SuperTwins reports that fourteen percent of their membership conceived without fertility treatments. Pediatrics published an article claiming that between 1997 and 2000, 17.7% of high-order multiples were conceived spontaneously. The CDC reported that there were 6,737 high-order multiple births in 1997. Even if none of those births were of quads+, John Elliott's estimate of 580 spontaneous triplet pregnancies would be 8% of the total.

How do you conceive spontaneous high-order multiples? Most of the time, you ovulate twice (the same profile as spontaneous fraternal twins), and then one of the embryos divides. A set of identical "twins" plus a fraternal baby is the classic makeup for spontaneous triplets. Far less often, a single embryo divides, and then one of the twins divides again: voila, identical triplets. Also rare, but not unheard of, is the set of three fraternal spontaneous triplets. It's not at all common for a woman to produce three ova in one cycle (most ovaries not high on drugs want to mature only one follicle at a time), but it happens.

When does spontaneous high-order birth happen? Hard to generalize, but it tends to follow the same patterns as spontaneous twinning: in the teenage years, when fertility is at its peak, as well as toward the end of one's reproductive life, when hormonal fluctuations (for the fertile, obviously) can also contribute to multiple ovulation. Spontaneous twinning, of twins or more, also seems to happen to the fertile in the early months of a relationship: the more sex you're having, the more likely you are to conceive during that oddball month when you've happened to ovulate twice.

So really, folks, enough already with the comments about how triplet parents deserve whatever they've got coming. Even if I'm willing to concede the point when it comes to those of us who used drugs (as so many strangers like to phrase it in the aisles of Target or on the streets where we live)--and hey, I think I've written enough conflicted posts about that subject--about ten percent of us didn't do anything more offensive than have sex. Granted, these folks redefine Fertile Myrtle, and that can be pretty offensive, or maybe a better phrase is bitter-making, if you're struggling just to conceive one, but the point is, no, not every triplet you see is an IVF baby. Besides which, every parent of triplets, at some point, loses patience with the way the mere existence of our kids somehow becomes a status-marker for the health and functioning of our sex organs. Please, can we make jokes about the triplets that focus on something else now? Did I mention that when you line them up together in a crib, they try to nurse each other's heads? That's pretty darn amusing, I think.

Reading Preemies in New Haven

Other people's sorrows and joys have a way of reminding us of our own: we partly empathize with them because we ask ourselves: What about me? What does that say about my life, my pains, my anguish?
-- Azar Nafisi, Reading Lolita in Tehran

Very apt. I came home from the West Coast, went right to Tertia's blog and read not only that her babies had arrived but that Adam had suffered a torn lung, and that Tertia didn't see him for several days after his birth. Naturally, my first instinct was to write about my own brush with that particular kind of pain. Gemma was quite sick after birth, herself, and I didn't see her right away, either. Indeed, practically the first words any neonatalogist said to me were, "You can't see Gemma right now, she might have a torn lung so we're doing another x-ray." I can't swear that my memory of my reaction to his words is accurate (for one thing, I was flat on my back, still coming off the meds for my c-section), but I don't remember any sense of panic. I don't think I was willing to allow myself any panic. I was trying very hard, I think, to be clear-headed, rational, and in control. Not to launch into a long digression, but I had just spent 6 weeks in the hospital convincing myself that the only way to get good care was to be a good patient, and I had an idea that the good thing to do when confronted by one's newborn daughter's possible impending death was to appear calm and support the medical staff. I can't see my baby because you're doing an x-ray and I'm lying flat on my back on a surgical bed with a catheter and various IVs hanging from my body? Alrighty then, keep me posted, old chap.

Granted, because I had spent so many weeks preparing myself to be good, and rational, and in control, I had also been reading and re-reading the Preemie book Julie just recommended. And I instantly recalled, as the words of that neonatologist hung in the air around us, that one of Dana Wechsler Linden's twin daughters had died, even though she (Elena) was originally the healthier baby, because of complications from a torn lung. So I'm not prepared to say that my public pose was my inner reality, just that all I remember is the public pose. All I was prepared to admit to myself was the public pose, in fact. And it is the memory of those days that has convinced me that divorcing yourself from your feelings, or dragging yourself kicking and screaming into the socially appropriate set of feelings, is probably less than productive. That's my fancy way of saying it's a surpassingly stupid idea. Obviously I had to accept my separation from Gemma in those hours after her birth, I had to let the doctors do their job, but I would have been wise not to pretend so convincingly to myself that it was alright that I be separated.

Several thoughts: it's very hard not to want to share this story with Tertia, to show some degree of solidarity, but it's probably not a Good Thing To Do. For one thing, Gemma didn't have a torn lung and she came home in three short weeks. Also, it looks too much like stealing thunder, using someone else's bad luck to talk about one's own, no matter how natural it might be. Finally, telling anyone that their pain or rage will someday no longer be at issue--because I can write this story and feel not a moment's twinge of emotion, it's an entirely past event to me as I type--while strictly speaking possibly accurate, might be precisely the sort of advice that, if taken to mean "stop feeling pain and rage," would only prolong the effects of pain and rage in the emotion-denying person's life. The upshot being, now is not the time to share with Tertia (or with Julie, whose account of a Connecticut NICU has been eerily familiar to me) my discovery, four years on, that all the anguish I felt while my babies were in the NICU--rage that I was missing their infancy, that they would never know I was their mother, that I had lost something I could never regain--faded into insignificance as time passed.

Also, I'm wondering: which is the more truthful set of feelings about that time? The feelings I suffered at the time, some of which were clearly absurd? Elba came home after five weeks, and Wilder and Gemma came home two weeks before her, and believe me, there were plenty of months of infancy left. Or the feelings of acceptance about the NICU, and even impatience with my former self, I now feel? I'm an historian, so I tend to privilege the feelings reported closest to the event. But those feelings of rage and regret turn out to have had an apparently transitory effect on my life. So this is the question I'm asking myself tonight: who truly understands and appreciates what it meant for me to pass through the NICU? The self of four years ago, or the self today?

* * * * * * * * * * * * * * * * * * * * *

I have a confession to make: I don't think having four-year old triplets is all that unique in the annals of motherhood. In fact, just right now, having four-year old triplets strikes me as considerably easier than having, as one dear friend does, children ages four, two, and newborn. So my anxiety about whether this blog is worth reading may not be quite so obnoxiously a move for reassurance (although it sure as heck looks that way now, and I wish I hadn't been so juvenile) but may just be another way of saying, what do I bring to the discussion of motherhood from the life I'm living today? I think the only answer to that has to emerge from the writing, but I warn you: I seriously doubt that much of it will strike anyone as especially triplet-esque. I reserve my right to change my tune when I have to fight with the principal someday about class assignments, but for now, the people writing about triplet babyhood probably have something more unique to report than I do. And my desire to write about selective reduction, or the NICU, or my incapacitating self-pity in the first year (don't worry, I'll get back to that) might unfortunately have as much to do with a longing for the days when I was "special" as it does with a desire to get some of the issues that used to matter taken care of, psychologically I mean. Take that for what it's worth.

It might be worth something to those women about to reduce an HOM pregnancy because the life of mothers with high-order multiples seems just too bizarre and weird and impossble. That might make writing about the normal, typical, quiet days of our lives entirely worthwhile.

Merry Christmas

I've read some intriguing Santa posts over the weekend, when I could get a minute away from my father, step-mother, and father-in-law. We did Santa in style this year, so it was, well, intriguing to hear from folks on the other end of the spectrum.

I have one vivid Santa memory from my childhood. We celebrated Christmas Eve at my grandparents' house (as all good Norwegian-Americans know, presents are opened on Christmas Eve) and one year, when I was six I think, Santa made an appearance. He knocked on the door, breezed into the living room, said some ho-ho-ho's, and left. Did he bring a present? He must have, but I cannot for the life of me remember it. I've been realizing all week that I don't have clear memories of any of my childhood Christmas presents. I do, however, have vivid memories of the presents I kept requesting, but never received, and of the toys my siblings received that were clearly many degrees nicer than the presents I was given. Make of that what you will.

That Santa existed was not in doubt. He came to Grampa's house, after all. I met him in the flesh. And I was completely enthralled by the entire event.

A few years later, I found the Santa suit and a cheap, flimsy white beard at the bottom of my mom's hope chest in our living room. By then, I knew Santa hadn't visited us, I knew Santa was pretend, but I was still surprised. "Ah ha," I thought, "that's what it was." My eight- or nine-year-old self was surprised that the beard had taken my younger self in. But if there was a devastating moment of loss--over lies or lost innocence or any of the usual Santa demons--I don't remember it. Doesn't mean I didn't feel it, but on the other hand, I came early to my intense enjoyment of nostalgia. It's entirely possible that my first reaction was the one that stays with me: "Wasn't that wonderful, way back then."

As a Christian, I have no problem letting Jesus share the holiday with Santa. Santa gets mentioned once a year, admittedly for a longer and longer stretch of time as the years pass, but he's contained. Jesus is ever-present and ever-important. Santa isn't in the Bible. Jesus is. (As an aside, I have more anxiety about my children building an altar, drenching it in water, and then wondering why their prayers don't bring down fire than about their questions regarding Santa Claus. They simply adore their Beginner's Bibles, and those stories about miraculous deeds worry me--I can barely explain to myself why God doesn't seem to do those things anymore, let alone offer reasons in the language of preschoolers.) Santa brings small presents that fit into stockings, and maybe something small that doesn't fit into a stocking. Jesus brings eternal life, beautiful hymns sung in candlelit churches, and the chance to perform the Christmas story in front of a crowd of adoring adults.

I was raised in the sort of Scandinavian-American household in which lutefisk, lefse, and the Tomten made predictable appearances. I respect that Santa Claus has origins in Saint Nicholas, but in my experience, he's closer in spirit and purpose to the Nordic tomte and nisse, or the Celtic faeries and sprites. I don't have any problem being a Christian and remembering that this is also the season of Yuletide. My ancestors spent thousands of years believing in folk not that different from Santa, and frankly, I'm not prepared to say they were wrong. They saw tomte and trolls in the forest; Elijah called fire down upon water-logged wood. The world used to be a far more magical place, I think.

Besides, I would never, ever, ever use the "Better be good or Santa won't bring presents" line. I find that offensive. Santa gives gifts at Christmas because Christmas is the day God gave us his greatest gift, the gift of Jesus the Christ. Jesus is love, and we show our love in giving. True gifts don't come with strings. That parent who "took away" Christmas by listing his sons' promised presents on eBay? If God had followed that sort of logic, we'd all still be condemned. The entire point of Christmas is that God's love comes through grace, in fulfillment of the Promise, not when we deserve it but precisely because we do not.

Indeed, Santa can be the most gracious giver to children at Christmas, because he doesn't stick around asking for thanks. He doesn't peer intently into your eyes as you open his presents, and then ask if you like the color or not. A week later, when you've dragged your feet about cleaning up the toys, you don't look up at Santa and wonder if you really deserve his largesse. Santa gives secretly, without ties of obligation or expectation. I find that a really wonderful idea. No wonder kids adore Santa Claus, even when their parents do enlist Santa in the language of bribes.

We had three encounters with Santa this year, and two of them were delightful. The mall Santa, accompanied by a woman who asked us to call her "Grandma," was a bit of a lump. Nice beard, authenticly "tasteful" faux-Victorian surroundings, but not worth much of our time. The Grandma thing irritated me. If you're going to be a mall Santa, you should at least preserve the illusion, I think. Mrs. Claus is no one's Grandma that I've heard of. Anyway, we have another Santa photo of the five of us, a crappy digital print with a truly ugly border, me in no makeup because I thought the kids were old enough to do the photo alone, and that's that.

But the other two Santa encounters? Lovely. The first was one of those magic moments: the day before Thanksgiving, we saw a man in a red flannel shirt and red Santa hat, complete with appropriate build and beard, shopping in our grocery store. The kids were not contained in the cart that day, and they stalked this man through the store, giggling uncontrollably and whispering fiercely, "Santa, Mommy, SANTA!" I didn't have the courage to lead my children up to this mysterious stranger--even though I'm sure it's only what he could have expected, you don't go out in that type of garb at the holidays and expect to pass incognito. Still, I'm shy, and I'm always self-conscious about being out with a brood of children who might start whining any minute, so we admired from a distance. We hid behind endcap displays and stared. The children giggled so hard, I thought they were going to break something, and I smiled so broadly at their excitement, my cheeks ached the rest of the afternoon.

The second encounter came at the Santa Train at our local children's museum. The train stopped up in the night-darkened woods near a brightly lit cabin, Santa walked down the train speaking to every child, and he offered innocuous but in-character compliments such as "You were only this high last year when I saw you!" "I can't wait to see you at your house." And the clearly-essential one, "What do you want for Christmas this year?" Because I didn't realize how young children are when they start to read their parents and react accordingly, and my children at least have already started saying things like "What do you want me to ask for, Gramma?" (No kidding, Gemma carted that one out with my mom last weekend, which I call wildy insightful, and pretty much the definitive summing-up of everything my mother is about.) With Santa, you can let your guard down and ask for the flimsy plastic trumpet you are already old enough at almost-four to know your parents think is trash. And your parents, in the guise of Santa Claus, can give it to you.

What will I say when someone asks The Question? Does Santa Claus exist? Well, what do you think? Do you want to talk about Saint Nicholas? About fairy tales and legends, about Beowulf and Thor and the Three Billy Goats Gruff? What about the Tomten? Charles Dickens? Clement Moore? For now, I can be charmed by the girls whispering together on Christmas morning, "Santa brought us three little presents! And one BIG present! And there are candy canes in the stocking!" Elba can pray on December 26th for Santa to get a good night's rest. And Wilder can announce on Christmas morning, "You're Santa Claus, Mommy" and I can get all flustered and say "What makes you think that?" (openly, not accusingly) and Wilder can already have decided it's more interesting to play with his new toys.

Selective Reduction: I give up

A couple whose husband posts on the Triplet Connection lost their babies late last week. The wife started experiencing complications at around 18 weeks, and she progressed into active labor at 23 weeks. I don't know if any of the babies were stillborn, but the last baby died after a couple of days in the NICU. The father had wanted to do selective reduction, and posted at the Triplet Connection 14 weeks ago, asking for help. All three babies were identical (No, I don't know how they knew this) and the parents had been told SR carried too high a risk of total pregnancy loss. I know you'll be shocked to hear it, but I'm one of the few people on the TC who tries to present a balanced view of SR when people ask about it there. I sent the father links to a few articles about the use of SR in high-risk MoMo twin pregnancies, just in case there was some chance their original anti-SR diagnosis was wrong. We corresponded privately, and I wished him well when they decided to go forward with the triplet pregnancy.

In light of their loss, my judgementalism about SR seems grossly out of place. Who am I to judge someone else's tolerance for risk? What I would like to do is provide factually accurate data about the risks: something I think neither the HOM nor the SR communities do very well as a whole. Be warned: my fact-heavy revision mutated this post into something far from fast-and-dirty. If your idea of a fun read isn't a heavily-annotated guide to multifetal reduction, now is the time to jump ship. Can I recommend dropping by Julie's place to read the latest updates on Charlie?

First, Cricket asked a very smart question, which I will paraphrase: if people pregnant with quads or more will find good medical evidence in support of SR to twins, why shouldn't triplet pregnancies also be reduced? The short answer is: diminishing returns. SR carries a measurable risk of total pregnancy loss. Depending on who does the procedure and what placental layout you're working with, the risk varies from 3-5% at a good facility with highly-experienced doctors to as high as 30% at other places.¹

In an October 2004 article in the Journal of Maternal-Fetal and Neonatal Medicine, "Embryo reduction versus expectant management in triplet pregnancies," the authors concluded that "In triplet pregnancies, embryo reduction to twins significantly reduces the risk of severe preterm delivery and very low birth weight by about one-third, at the expense of a significant increase in total fetal loss, by about one-quarter. The procedure is likely to reduce the risk of having a severely handicapped child due to extreme prematurity." (The severe handicap numbers they quoted were 0.63% for the reduced group versus 1.64% for the non-reduced group.) This was a retrospective study, not ideal for clinical findings, but typical for IVF/HOM research. There were 255 trichorionic pregnancies examined; 185 were reduced, 70 were managed expectantly. The most provokative discovery? 15.41% of reduced pregnancies resulted in total fetal loss versus 4.76% in the non-reduced pregnancies. Most of the disparity arose from the miscarriage rate: 8.11% in the reduced group versus 4.76% in the nonreduced group.

Setting aside the risk of miscarriage, another recent study found that 35% of placental environments after SR showed chronic inflammation.² This helps to explain why SR, even when it improves the outcome of the pregnancy, doesn't lead to outcomes exactly the same as originally-occuring pregnancies with the same number of fetuses. In other words, an SR twin pregnancy will not, on average, do as well as a twin pregnancy that didn't become one through reduction. To quote numbers, in the USA, the average quad pregnancy lasts 30 weeks; the average triplet pregnancy lasts 33 weeks; the average twin-SR pregnancy lasts somewhere between 34 and 36 weeks (I keep finding new studies, and the numbers fall all over that range); and the average twin pregnancy lasts 36 weeks.³ Getting from 30 weeks to 34+ weeks offers a reasonable jump in overall outcomes, including those involving maternal health, but the jump from 33 weeks to 34+ weeks is, on average, fairly small.⁴

It's worth mentioning at this point that 95% of 30-week babies survive, and that 95% of the survivors will suffer no major disabilities. (I get my statistics for this from one of the best premature-baby medical sites on the web, that of the University of Wisconsin Pediatrics Department.) Of course, the average woman carrying quads will have experienced many more complications, and endured many more interventions, than the average woman carrying twins.

Now for the problem faced by that couple I mentioned at the beginning: the problem of total pregnancy loss. We simply do not know how many pregnancies begin as HOM but end with two heartbroken parents and three or more dead babies. The Center for Loss in Multiple Birth (CLIMB) tackles this issue at some length. Women on the SR boards like to write that there's a couple who suffered total pregnancy loss for every couple who takes home babies at the end of their HOM pregnancy. The medical facts we have don't begin to support that number: the average delivery wouldn't be 33 weeks for triplets if half of triplet pregnancies were lost at around 20 weeks. The number is probably somewhere between 10 and 20 percent overall, that October 2004 article above notwithstanding. And who wants to risk a 10 to 20 percent risk of total loss?

Unfortunately, once you've conceived an HOM pregnancy, you're already screwed on the medical front. You're facing a frightening, paralyzing risk of total pregnancy loss regardless of what you do. The SR procedure carries, on average, probably, a 5-7% risk of total loss, with the irony being that the less access you have to experienced SR doctors, the less access you have to experienced HOM perinatalogists, too. Twin pregnancies themselves carry a risk of total pregnancy loss, probably in the area of 3-8%.⁵ Looking at those two numbers together, SR improves your chances to some extent, but not necessarily enough. Meanwhile, we know that SR improves pregnancy outcomes on average by 1-2 weeks for triplets reduced to twins, and 4-5 weeks on average for quads to twins. But what we don't know, because no one has done a good study on this, is how many of those reduced twin pregnancies are still going to deliver at 28 weeks or before. There's no clear evidence to show that a woman whose SR twins were born at 24 weeks would have delivered her quads at 19 weeks. There's no clear evidence to show that a woman who delivered her SR twins at 37 weeks would have had complications if she'd gone forward with triplets. Maybe the quads mom was screwed regardless, and maybe the triplet mom could have done just as well without selective reduction.

No one has done the damn studies. No one, not one single medical researcher, has begun a database of all women who present to REs and Peris and OBs with multiple pregnancies, and tracked exactly what interventions and complications they experienced, and what exactly were the outcomes for all their originally-conceived fetuses. We certainly don't have the kind of database that would allow us to apply outcomes data to women with particular medical histories. Find two or more heartbeats on U/S at your RE's office? Your RE will have only the most limited information to give you about your particular set of risks. It's maddening.

So here's my advice, if you somehow stumble onto this site through a google search (I doubt I'll ever rate, frankly) or if you end up here via an infertility blog link (hey, I'm on a few lists now--and by the way, thanks, that's very cool of you).

1. Only implant two embryos. I know, I know, I know--but look. Just. Don't. Do. It. You're infertile, the statistics have already screwed you. You have no reason to believe you're not going to end up on the screwed end of the margins again. Two. Embryos. Only. (I hereby call upon getupgrrl for backup on this point.) And do keep in mind that the rates of monozygotic twinning are considerably, markedly higher in IVF, especially 5-day blastocyst transfer, so even two embryos might still lead to three or more babies.⁶ Remember those stories about the quad moms with the two sets of MZ twins, and how they had beaten 1 in a million odds? Only, hmmm, there were two sets of those babies in less than six months? That's because with IVF, the odds of twin twins in one pregnancy is exponentially higher than 1 in a million.
2. Too late? Whatever you do, DO NOT take SR advice from your RE. Do. Not. Do. It. REs who see more than two sacs on their monitors are all thinking the same thing: Fuck. Shit. Bullocks. You didn't go down to the NICU for help getting pregnant, don't hang around your RE office looking for advice about HOM outcomes. Get thyself to a perinatalogist, ideally one working at a university hospital, certainly one associated with a hospital that includes a Level III NICU, and get thyself there NOW. Find out how many HOM pregnancies that perinatalogist has managed in the last year, how many SR procedures their affiliated doctors do, and proceed accordingly. (If either answer is less than 12, go out and find another perinatalogist.)
3. Allow me to quote a TC member who suffered a total loss for this next part. Her name is Steff, and she lost her babies a year ago at 19 weeks. First, she says she's sorry now that she ignored the SR advice of her doctors at the time. Then she writes:

   I would ask a lot of questions [about SR]-- why, specifically, they think I am at risk; what specific issues they expect that I would face, etc. If I were to determine that their concern was just a general concern that they share for all HOM patients, then I would consider that as I carefully weighed statistics, etc (it's terrible that that's what it comes down to). If their concern was more specific to my particular pregnancy ... I would listen very carefully. I would ask how many parents they've treated in similar circumstances who had gone on to have successful pregnancies ... and how many turned out otherwise.

4. If you can't restrain yourself from becoming Dr. Google, do a search on PubMed for multifetal reduction. Browse the bibliography at CLIMB. And please, don't feel that you have to pretend that medical issues are the only nightmares keeping you awake nights. With SR rates estimated at 33-40% in the USA (and the studies I've cited showing rates as high as 72% at major urban ART clinics), clearly a lot of multifetal reductions are done for reasons people don't always like to admit: lifestyle issues, simple economics, and the vivid dreams about parenting that sustained them in the midst of ART. Amy Richards, for all that her "Lives" piece in the Times Magazine was a mess, offered a marginally coherent explanation about reduction vis-a-vis economics/lifestyle in a private letter published online. (As an aside, when Amy claimed that it would be easier for her son to know that two siblings were aborted than adopted, I think she revealed some disturbing personal--and cultural--biases about birth parents, adoptive families, and adoption generally.) Another good article to consider? K.S. Collopy's April 2004 piece, based on interviews with folks she found on the internet: "'I couldn't think that far': infertile women's decision making about multifetal reduction."
5. Now you might want to visit an SR board or two: the boards at INCIID and Fertile Thoughts seem to generate a fair number of responses to new posts. There are active pregnancy/parenting forums at both the Triplet Connection (TC) and Mothers Of SuperTwins (MOST). But keep in mind that the multiples groups will be mildy to profoundly anti-SR, and the SR boards are kept active by folks with their own set of biases and beliefs. If you find yourself drawn to one community or another, you're probably already more than halfway there in your decision.
6. Decide what to do, do it in the best setting possible, and please don't second-guess yourself. You did what was right for you. Good luck with your pregnancy. If you're still carrying HOM, get the pregnancy packet from the TC and please, whatever you do, make sure you're getting weekly monitoring from 16 weeks onward. Things can get tricky at 16 weeks, whether you reduce or not, and you want to make sure your doctors know you need a cerclage before it's too late.

Okay, that's it. I can't promise I won't revisit the issue later, but I'd rather not. The whole issue hurts my heart. I hate infertility.

Footnotes:

1. The rates of pregnancy loss after multifetal reduction are all over the place. A December 2004 article in the American Journal of Obstetrics and Gynecology examined 290 multifetal reductions at a top clinic in the USA and discovered a 6.5% total loss rate: 3.5% when done transabdominally and 13.3% when done transvaginally. Back in 1997, E.R. Norwitz and A.C. Vidaeff found mean total loss rates of 17% (within a range of 5-30%) as discussed in their article "Controversies in Multiple Gestation," Contemporary OB/GYN, 42(12), 54-88. (I'm sorry, I can't find a link to the article on PubMed, and I don't want to use the link via Medline for fear it will be broken for those on non-university ISPs.) The question is, what are the rates at your clinic? They vary wildly, such that posters on the SR boards almost always advise people to travel to major cities for the procedure.
2. The article, published in June 2001 in the Journal of Maternal-Fetal Medicine, was titled "Shortened gestational age following multifetal pregnancy reduction: can chronic placental inflammation be the explanation?"
3. Mothers of Supertwins has posted a collection of SuperTwin Facts, including average gestational ages, compiled from survey data they collected between 1987 and 2000. John Elliott, the so-called "Quad God" at Good Samaritan in Phoenix, provides some rough estimates on gestational age in an internet article on managing HOM pregnancy.
4. One of the medically-literate members of the TC forum posted a very, very long summary of an April 2003 article regarding HOM pregnancy outcomes in Current Opinion in Obstetrics and Gynecology.
5. The National Organization of Mothers of Twins Clubs (MOMTC) last updated their chart on twin outcomes in 2002: it includes figures for 1997-1999 and seems to suggest a total fetal/infant loss rate in twin pregnancies of approximately 4%. In their abstract for an article, "Fetal reduction from twins to a singleton: a reasonable consideration?" Mark I. Evans et al. write: "physicians know that spontaneous twin pregnancy losses average 8-10%." They reference the 1999 reports of the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry in support of that number.
6. There are a lot of articles on monozygotic twinning rates in IVF. One good place to start, especially if you love chasing footnotes, is "Monozygotic twinning following assisted conception: an analysis of 81 consecutive cases."

Selective Reduction: The background

I wanted to write something thoughtful, even philosophical, about our decision not to reduce. It turns out that even an account of the bare facts mires me in the online equivalent of stuttering. Nevertheless, at some point, I need to get the subject behind me. This is part I, in which I lay out our rejection of SR before the fact. Soon, I'll take on the job of explaining how our entire world view shifted once we knew it wasn't a theoretical position.

But right at the outset, I reluctantly concede to myself that I'm duty-bound to declare the reason why I've been so reluctant, so unhappy, about writing about SR. It would be intellectually dishonest to do otherwise.

I think people who reduce from triplets to twins have made a huge mistake.

Every time I read the selective reduction boards, every time someone advocates reducing triplets in the comments section of some blog, I feel this visceral outrage, and a horror in my gut. As easy as it is for me to understand and emphathize with the entire gamut of family-building practices (and it's really easy, I think any and all routes are great, I'll get excited for you to the exact appropriate degree without becoming condescending and beginning to believe my opinion actually matters*), that's how hard it is for me to understand how people could reduce from triplets to twins. To some extent, the disconnect unnerves me. To feel so judgemental and pissed off doesn't fit my idea of myself.

SR in the case of quads and more, I understand. I ache for families facing the statistics on quad+ pregnancies, and I'm grateful I was spared that decision. We certainly never predicted triplets based on my estradiol or follicle measurements, so it could probably just as easily have been quads, or even quints. I'm exceedingly grateful it wasn't, because once you're carrying quads or more, the statistics are indeed stacked in favor of SR. And I would have hated facing that decision.

But to reduce from triplets to twins? Neither the statistics on medical outcome nor the realities of triplet family life justify reduction (at least not the various non-financial scenarios of triplet life I've seen invoked on-line, most of which are pure media-invention fantasy) . And it drives me a little nuts to find myself believing this so strongly. I should be a lot more tolerant, I think. I'll be looking for tolerance when I compose the second half of this story.

---

We ruled out SR at our first RE appointment. Saying we ruled out SR, though, was simply one way of saying that we refused to pursue any protocol in which it might become an issue.** I don't think either Calder or I ever ruled out SR simply on the basis of its mechanics. In general, we're pro-choice in our politics, and I grant no scientific arguments against abortion in the first 16-18 weeks. I do know that I had a gut instinct that making that decision -- to abort one fetus in the midst of an otherwise-wanted pregnancy -- would cause me extreme emotional distress. But I also knew that most women who choose abortion express contentment with their decision--they report feeling that whatever grief they experience is appropriate and not debilitating, or even terribly long-lasting -- and I knew in the abstract that SR could be the humane choice under certain circumstances. It simply wasn't right for us.

At this point, I'm duty-bound to disclose that Calder and I are church-going Lutherans. I embrace every truth revealed and celebrated in Psalm 139. But wait, wait! Before you hightail it out of here, it's on the basis of that same Psalm that we'd like to see the church normalize the status of gays: ordain homosexuals regardless of whether and when they last had sex, provide a marriage ceremony for homosexual Lutherans (the current one references God creating us male and female for each other, but most of the liturgy requires no amendment or alteration), welcome homosexual parents at the baptismal font, etc. I'm pro-choice, anti-voucher, anti-prayer in schools. Just consider me a Lutheran in the old-fashioned progressive "live and let live, hard to say what's right, you betcha" Garrison Keillor sense of the word (but not so inhibited, obviously).

Nevertheless, I never felt that my opposition to SR was based on religion. If you had asked Calder and I to explain why SR was off the table in January 2000, we would not have quoted the Bible. We would simply have said that it felt wrong. We certainly did not express, to ourselves or others, the sentiment that Julie finds so dominant in HOM stories, that "whatever happens is meant to be, that God will give and take away according to his wisdom." On the contrary, I spent a fair number of Sunday mornings raging against God, because if you sneak into service late after an "early"-morning appointment with your clinic nurses, you will find yourself stuck worshipping with all the families with small children. This is unpleasant, even if not ironic.

No, our oppositions felt rooted in behavioral ethics, not religious scruples. Most of what Calder and I knew in 2000 about SR came from the stories about the sex- and septuplets in the media. We tended to talk about the procedure between ourselves as a "cheap escape" for couples who pursued blatantly irresponsible ART protocols. Of course, I know a hell of a lot more about SR now, and I would never label it a cheap escape. But there's no denying that it struck us that way then. To consider or embrace SR, it seemed to us, entailed considering or embracing irresponsible treatment options. We were determined to do neither.

This was the background to our discovery that we were carrying triplets: we had ruled out SR, but not for especially well-thought-out reasons. It was simply a gut instinct, and one of several lines in the sand that we had felt called upon to draw before entering the process. We had seen too many people plunge further and further down the rabbit hole of infertility treatment, forgetting their way back home, changing into all sorts of unwieldy new sizes, psychological as well as physical--maybe good choices for them, but not for us. Calder and I made some promises to each other right at the beginning, and we intended to stick with them. No SR was one of those promises. But never forget that "No SR" was really a promise about protocols -- rejecting it helped define our outer limits.

---

* I simply adore Gaudy Night and there's a great passage in the latter half of the book that's entirely on-point. Peter Wimsey comes to dinner at Shrewesbury College and advises one of the dons (maybe even the Head) that she should not ask him "that tired old question, whether I approve of women's education or not." (I'm paraphrasing.) And when the Don asks, why not? Wimsey replies, "you should not imply that my opinion in any way alters the rightness of the case." Or words to that effect. Dorothy Sayers is a much better author than I am. Obviously sexist, but still.

** In retrospect, our RE should have explained in simple, direct language that the only protocol in which high-order multiples are 99% guaranteed not to occur is single-embryo IVF. Where that would have left us, I don't know--we were dealing with a separate set of issues regarding IVF, and had ruled it out. I've always suspected that we would have plunged down the rabbit-hole ourselves, given enough time. In retrospect, we were sidling over toward that direction during the cycle in which we conceived the babies.

Full Disclosure

First, the kidlets are almost four. There is no way on God's green earth (or whatever colour it becomes as the Bush presidency continues) that I had time to post missives on the internet when they were babies.

Speaking of which, I barely left the nursery--let alone the house--until the babies were almost nine months old. Long story, maybe I'll regale you with the details some day. But when I think back on that time, and my incapacitating fears, I suffer physical pain. I wish very much that I could go back in time and (a) offer myself a big hug and (b) tell myself to get over it already, and get the heck out of the house. What's the worse that happens? I'm nursing one baby astride the passenger seat of the minivan while the other two wail in their carseats? I have to abandon the almost-full grocery store and return home immediately because I didn't pack enough diapers? Turns out, neither scenario is as bad as it might appear.

Meanwhile, a tip for anyone trying to grocery shop with multiple infants or toddlers: push the stroller, pull the cart--and this is key here, pull the cart so it rolls forward. Grasp the front of the basket on the cart, not the handle. Do not attempt to pull the cart backwards--bad idea. But you can push a double stroller or a triplet stroller while pulling the cart (your right hand can do double-duty, wrap a few fingers around the stroller and a few fingers around the cart), and you'll never need assistance in the grocery store again. At least not until you want to discuss why, exactly, the cheap toys are displayed precisely opposite the breakfast cereal, and what became of the lovely, now-obsolete idea to provide candy- and junk-free check-out aisles.