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In the first part of this interview [click here] Lee-Ann Charszewski talked frankly about the shock of discovering that she was having twins, the physical and emotional struggles that come with a multiple pregnancy, and her experiences in the delivery room. In the second part, she opens up on post-partum depression, breastfeeding and changes in family dynamics.

Can you compare your C-section recovery from your first pregnancy to your second? Can your remember some similarities or differences or was it all just blurry? 

I remember them both vividly because of the pain. I had the morphine drip for both of them and I would highly recommend you follow the doctor’s orders on that because you can’t imagine the level of discomfort you have with a C-section. I think people underestimate what a C-section is. People think there are two ways of bringing a baby into the world. A vaginal birth which is the natural way to bring a baby into the world or a C-section. And I think it gets put in the back of people's heads thinking, "Oh, it's just a C-section."

"I remember both recoveries vividly because of the pain."

In fact you're going through the uterus, the abdominal wall and your fat and it's a significant surgery which requires at least 6 weeks recovery in addition to the fact you now have to care for somebody else. So I think people really need to weigh the pros and cons of a C-section. It is really a significant surgery with risk, and the recovery is pretty long and painful if you're not well medicated, so there's no way I wasn't having a morphine drip. It's protocol. And you can still breastfeed the babies through it, which I did. 

Did you find that the level of pain after your second pregnancy was different than the first? 

I'd say the same. You get a lot of gas pain. I don't know what they do with the drip and the spinal and the pitocin, but it bloats you. And it gets trapped in your body and it is very, very painful. There's no other way to describe it than painful.

I couldn't hold Adam for 3 weeks afterward. You can't get out of bed, can't get up to get your babies. You have to have somebody helping you and bringing the babies to you because you physically can't move. Now, some people may respond better, but I did not. I was one of those people that did not respond well to a C-section. 

What about things like going to the bathroom? 

Ugh! Absolutely excruciating!. I had to have a nurse come in and rub my back as I worked through the tears. It was so bad I vomited. 

Could you get out of bed to go to the bathroom? 

Barely. I could hardly get out of bed for days. 

Did they ever consider using a bed pan? 

Yes, I had to use a bedpan and I was on a catheter for 2 days. And you can't do a Number 2 for days because you're on codeine. It's a challenge. It's a huge, huge challenge. Never mind the 2 babies who are at your breasts, who are now having trouble on top of it. 

They were having trouble? 

Yeah, by the time I left the hospital I already had cracked and bleeding nipples and shortly thereafter I got 2 cases of mastitis. To me that was the biggest challenge of all. 

So how long were you in the hospital? 

I was in the hospital for 4 days. 

That's standard for a C-section? 

3-4 days. They like you out by 3.  

At the end of that did they say, “This is the day" or did they say, "You're fine." Because they need to weigh the babies, and look at you. 

Well, I think they had a particularly close watch on me because I had postpartum depression with Adam. On the first night they watched me closely and I was in tears, crying uncontrollably because the babies were on my breasts every 2 hours. They had a social worker come in to check on me the next day. She was in with me for probably about 45 minutes. That's about typical protocol in assessing how I'm doing. 

She was asking questions, probing difficult questions to see my mental state. Also to find out what kind of level of support I had at home. I was just exhausted and exhaustion can contribute to postpartum depression and your hormones, now that the babies are here, are going crazy and this is when you're at risk. I had to assure the social worker and I had support at home, that I was OK, that I had made sure I had built-in support. I told her about the doula, the round-the-clock care with my mother and mother-in-law for 6 weeks. One of the struggles I had afterwards was that the babies were losing weight. They had lost close to 10% of their body weight.

One of the reasons I went back to Trillium is because I had worked there. I had worked in the wellness centre which was kitty-corner to the lactation or family care centre, so I knew the lactation consultants really well. I had the same lactation consultant that I'd had the first time around. She knew me and my circumstances the first time. So, when she came in to discharge me she was concerned about the weight they had lost, but she knew I had made a commitment to breastfeed the babies.

So she just booked me in with the lactation consultant 2 days after discharge and she put together a breastfeeding plan that I had to follow. It was going to allow me to let the babies take pumped breast milk in a bottle so that I could get some sleep. It was very structured, very planned, to ensure that I was leaving with 2 babies and support. Even a lactation consultant knows the risks of postpartum and the challenge of breastfeeding 2 babies. In fact, she'd had twins herself. She had trouble with the breastfeeding herself as a lactation consultant. I feel fortunate that I had the circumstances that I had.

Did you ever feel overwhelmed? 

I didn't feel overwhelmed by their care because I had set up support and that is - if I can give any bit of advice to any mother expecting - is you need to have support. You need to be able to sleep. You need to know that life is going to be completely chaotic and different. Particularly with my having the twins and already having another child to care for, however that support looks.

"If I can give a bit of advice to any mother expecting -- you need to have support."

Whether you have a teenage girl that lives down the street who comes in to act as a mother's helper while you sleep, makes the beds or entertains your 3-year-old, reads books to them. You have to have that all done before the babies come. All done and organized. 

What you're saying is so logical and so practical. I think there's this pervasive idea a lot of women have during pregnancy... "I'll do it myself, I'll prove to the world" And that they'll do it all intuitively as well.

Some women do manage and I think they should be congratulated. But I think for most women, it's a rude awakening.

I appreciate you being so specific about these situations. 

I didn't organize a mother's helper until 6 months down the line. You can get help through your community or your church, but I didn't do that. I didn't realize the scope of how big this was going to be, but there are some things I did do right.

I had family and friends cook meals for me, large casserole dishes, loafs, dishes you could just pop in the oven and heat up. Honestly, I don't know what I would have done if I hadn't done that because you need to eat a lot. You need to breastfeed babies, you need to feed your child.

My family cleaned the house for me. It was just a complete whirlwind like we were trapped in this cycle of business. Perpetual duty. It's still like that to this day. It's very, very, very busy and overwhelming. I don't know how these people do with sextuplets or triplets even. It's pretty intense.

I still think I'd love to talk more about the whole breastfeeding commitment. You were talking about how women think they can do it intuitively. 

Well, let's talk about breastfeeding. 

Breastfeeding for me was my gift to my children and was the most important part of me giving birth to these babies. I was committed to breastfeeding them. I believe in breastfeeding. I believe in the health benefits for the mother and for the children. It's cheap when you're talking about feeding 2 babies and the cost of formula over 12 months. That's going to be close to $4,000 and I really wanted to make a commitment to making breastfeeding happen.

"Breastfeeding was my gift to my children and the most important part of giving birth to these babies."

I also knew in the back of my head that I may not be able to make it work because would be such a huge challenge to do it. I had pretty significant breastfeeding problems with my first child, Adam, I had mastitis with him. But I was just convinced, because I'm the eternal optimist, that I could do it. It was really, really tough, the hardest thing I've ever done in my whole life. I'm a very driven personally, very positive, very focused. I don't give up easily. I had to play tricks with my mind to be able to get through this every 2 or 3 hours. 

Tell me some of the tricks. 

So, first and foremost you can't demand-feed twins, you have to put them on a schedule. The doctors said babies nurse when they want. You can't do that with twins. You would be a milking cow which you are already, because you're feeding around the clock. You do have to hold one off when the other is hungry. You have to keep a chart and put them on a schedule. You have to decide who is on which breast last because you have to switch. You have to keep stringent records of when they feed, especially through the night.

I would get the doula to bring the babies to me in the night at the same time and feed them at the same time. In terms of the tricks of letting myself get 2 or 3 hours of sleep, you certainly can't breastfeed twins if you don't have someone that can get up for you in the night and bring them to you at the same time. You cannot do it all night without adequate sleep. You have to have your husband get up, you have to pay for help if you're going to make that commitment to breastfeeding exclusively.

I exclusively breastfed these babies, they've never tasted formula. I didn't do any supplementing at all because I built up my milk supply. I think that's where some women get off track is because they feel they can't make enough milk, but you can, you have to keep the babies at the breast. You can't start supplementing because then you'll lose your milk supply.

One of the problems I had was an over-abundance of milk supply, possibly because the babies had trouble latching. When you have a lot of milk the breasts aren't as soft and the nipples become harder for the babies to get onto. Because I had an over-supply of milk then you get problems with cracked and bleeding nipples, you’re more at risk for mastitis. And that's exactly what happened. I got mastitis. Probably about day 10 as I did with Adam on day 10.

I think mastitis is as painful as a c-section. You get a full fever, you're shivering, it is so painful and you're so tired, I had to go to the clinic. They said, "give your breasts a break." I said, "Tell me how I'm going to give my breasts a break; I'm feeding two babies at the same time!" There's no room to give your breasts a break. Pumping is always an option as well, but pumping is pretty hard, then the babies don't take the bottle. Once you make the commitment to breastfeeding you have to make the commitment, because it's not easy to wean at that point.

One of the tips I got was to focus on breastfeeding as a positive thing for my babies and the discomfort I was going through couldn't be as bad as what was going on in other people's lives. At the time, Maher Arar’s case was in the news. He was the Canadian torture victim, wrongfully imprisoned. He had won his case, $1.9 million. That was in January or February of '07. I was watching a lot of TV at this point because that's what you do, you sit in front of the TV breastfeeding.

It was really hard, the pain I was feeling, so I just said to myself, "If Maher Arar could live through that torture, take his case and have them recognize that he had been tortured and that he survived that with children to think about at home and his wife, then I can survive the uncomfortable feelings every 2 hours of babies at my breasts because I was giving them a gift. So, I just had to focus and put it in perspective. Feeling really isolated and down and sad. I was deciding to do this, I had the choice to end it if I wanted to. 

So Maher Arar helped you breastfeed? 

Yes! [laughs] He doesn't know it. 

Well, he has a website and you can send him comments. I'm sure that one would be unique. 

It would be unique. He gave me a little inspiration to focus on. I'd also given myself a timeline in my head of how long I wanted to do this. It was going to be 4-5 weeks and it started to get better at that point so I was able to continue. And who else was able to get me through breast feeding? Oprah and Ellen! [laughs] It gave me something to look forward to every day as I sat on that couch. It kind of became a joke in my household with my mother-in-law.

We just had to laugh a little bit whenever we could. Like, she'd come in and I'd be walking around with no shirt on because my poor breasts were in such bad shape and I would say, "Hi mom!" to my mother-in-law, with my shirt open. You lose that sense of... modesty. We just had to laugh about it. On would come the Oprah show and I'd say, "It's that time of day again!" The Oprah jingle would come on, then the Ellen jingle... every day it was just the same thing. You just have to get into a routine. It just helped me to keep my sanity. Helped me to stay focused on what I wanted to do. And the doula in the night. I had around-the-clock emotional support, I did very well emotionally. 

"The Oprah jingle would come on and it would help me to keep my sanity."

Did both babies latch on quickly? 

No, they struggled, particularly Colin. He wasn't thriving, he wasn't latching. When you think your babies aren't thriving it's a sign of postpartum depression. And I was very concerned that night with the nurse. That's when the nurse said, "Is she doing ok because she thinks that her babies aren't thriving?" 

Is this when you went to the lactation consultant? 

The hospital had in-house support. I called on them. When you have a second child the support doesn't come quite as quickly. I found they weren't rushing in to help me. I had to keep buzzing. I said, "I asked for a lactation consultant 4 hours ago, I'm in this room nursing twins, please send somebody in now." I started to get quite upset. They're not used to seeing a lot of twins because a lot of them end up in special care. Anytime a nurse came in it'd be, "Oh, there’s two in here!" I found that a bit of a challenge. Whether it's just nursing shortages and they're all overwhelmed or because “She'll be ok, she's had one already." But it's different when you've got to strap on two. 

When you got home, did you consult a lactation consultant? 

My doula was also a lactation specialist. I chose a doula with a specialty in lactation so I had built in round-the-clock lactation support. With latching, she would bring me the cabbage leaves, one of the tricks and tips. She was one of the reasons why I continued to breastfeed because she helped me continue my goals of breastfeeding. She supported me in a gentle way by not bringing formula into the house when I requested it. She did at one point say, "I will pick you up a small can." I still have that can. It's probably expired now. Yeah, it's about time to throw it out. She never said, "Ok, now's the time." I was to make that decision. 

You said around 4-5 weeks it got better. How would you describe that period? 

Thank goodness they didn't have colic like Adam. It became easier, my commitment to those first 5 weeks. If you can do it, it's much easier to breastfeed babies than to formula feed them. You can't feel guilty to make the decision to formula feed babies because they'll be fine and you have to do what you have to do. You have to sleep, the babies will be fine, but if you can breastfeed it is easier in the long term, and cheaper. If you don't have support I don't recommend breastfeeding because it's such a challenge. 

The chart you used to track their feeding, was it something you made yourself or was it something you found? 

There were some charts on the Multiple Births Canada website [http://www.multiplebirthscanada.org/english/index.php] which I referred to, but I ended up having my husband modify it and using a slightly different chart. I found the charts prior to the birth of the twins. I also joined Bay-Area Mother of Multiples. I still belong to that.  

Are there a lot of members? 

There're about 250. 

And this covers what kind of area? 

It covers the Oakville, Hamilton, Burlington area. I've enjoyed that support group as well. I thought I'd embrace them more than I did, but you don't have time. With my first-born I went to a lot of mothers’ functions, but all that changes when you have twins and a 3 year old. It’s just truly about survival. 

"Everything changes when you have twins and a 3 year old. It’s just truly about survival."

Did you leave the house during the first couple of months? 

Yes, my mother in-law would watch the children while I went to the grocery store. Oh! The grocery store! What a treat! I'd never thought going grocery shopping would become such a treat. I'd go up and down the aisles; I'd look at all the ingredients. I'd say, "This is just freedom!" In the past it was just throw everything in the basket, get the necessities. Now I made a trip out of it! An experience, an awakening. I would chat to people in the line-up. I'd felt so trapped like I'd had cabin fever. It was like the first time I'd ever gone grocery shopping. It was like I was reborn. [laughs] You really appreciate the basics of life when you've been so needed by these little people. 

I made my first trip out at 6 weeks, got them loaded into their double stroller and walked into my local mall, Hopedale Mall. The very first person I saw was a young man looking over at me with wide eyes. I knew he wanted to come over. I looked pretty tired and bedraggled. My goal was to get out. There was no lipstick, no pretty hair. I just got out. That was my goal. To feel proud of myself for getting out, walking a bit, starting to get fitness going.

So, this man came over and said, "Are those twins?" I said, "Yes they are, they're fraternal twin boys." He said, "My wife is 25 weeks with twins." And now I'm friends with her to this day. I got her to join the Bay-area Mothers of Multiples. She walks with me. She has twin boys that turned 1 in June and we have been a support for each other. I helped her through those last few months of her pregnancy. I was able to give her some clothes and tricks and tips.  

She must be so grateful. 

I think so. She's quiet and reserved, but she ended up hiring a nanny based on my recommendation. She had no help. I said, "You must get help," so they hired a nanny right from when the twins were born. She had hers to start a little earlier to help her prepare and cook and everything. She says she doesn't know what she would have done if she hadn't had the nanny. 

So, the cabin-fever after the twins were born, can you describe that? 

I didn't feel it as bad as I did with Adam because I didn't have the round-the clock support with him. Part of the cabin fever with my firstborn was feeling so alone and down with the postpartum, wondering if this was normal. The shock of going from footloose and fancy-free to being completely committed to this little baby that cried 12 weeks straight. Thinking "what have I done?" A whole change in my lifestyle.

With the twins I'd adjusted to the thought that life was different when you have someone you need to be responsible for. I had the babies in the dead of a cold winter, but I had my mother-in-law to talk to and my mother. They gave Adam some attention, dropped him off at nursery school. It's all about having support and having mechanisms that allow you to be social. Going to the Ontario Early Years Centre and forcing yourself to do it. You must get out. You must go to the library for the whole afternoon if you need to. 

 

The twins at 2 months. (photo courtesy of Lee-Ann Charszewski)

Did you experience postpartum depression after having the twins? 

No, I felt joy this time, a connection, whereas I didn't feel that with my first child, which I feel terribly guilty about. I knew I was much better this time around with the twins. Things started to develop into a structured routine. 

How long were you away from work? 

I was off work for approximately 9 months. Two of those months were because of medical leave prior to their birth. I actually went back to work about a year ago, so I returned to work 2 days shy of their 7-month birthday. My husband is a full-time caregiver. 

So he's at home now, he's not working? 

He's at home; he quit his job and stayed home with all three children when the twins were 7 months. 

How long were your mother and mother-in-law an integral part of the routine? 

They still are. My mother comes by every two weeks; my mother-in-law comes 2 or 3 times a week. She's only 5 minutes away. It also gives her the opportunity to be with her son and to spend time with our children whom she loves. To her it's not a burden, it's something she enjoys doing, but we appreciate her so much, she's such a wonderful woman. 

So the sense of respect and closeness for you with your mother-in-law has changed because of the twins and the pregnancy? 

I think me being pregnant both times created an opportunity for me to see who she really was. She's always been this generous, thoughtful, kind, giving woman. She really went above and beyond anything to support us as a family. She's an outstanding lady, she really is. I'm just so grateful to her. I could cry just talking about it. 

It's a nice by-product of the whole experience. 

Yeah, it's brought us really close together. She misses that, actually when I went back to work. I try to have her over as much as I can, but she doesn't want to impose because she know what kind of commitment it takes for us to put a barbecue together and have everybody over. It's busy, it's hectic. She’s very undemanding. 

Would you say that overall the dynamic in your family has changed? 

Help help help - as in they gave lots of it. With the breastfeeding, that was a challenge. It was hard on our marriage. You have to accept the fact, you and your partner, that life has changed and that it's not about me, it's not about my husband; it's not about us for quite some time. Even now at 18 months, it's still not about us. You just have to be strong enough to know that this will impact your marriage and it may fall apart if you don't recognize this because it puts a lot of pressure, you're both sleep-deprived, the children are challenging, they'll push your buttons. It's very hard on the older child whose behaviours will most likely deteriorate, which challenges you even further. Things like romance, things like sex go away.

Are you able to talk at all? Do you have good conversations? 

Well, if your husband's that kind of man. [laughs] I have a wonderful, kind, sensitive, loving husband. He's like many men who don't talk about their feelings, but he would if I spoke to him about it. We're just so busy to even talk about that. I know it sounds like an excuse. We just know intuitively that it's not about us right now. So when we talk about going away on vacation, it's very hard to find somebody who will take care of three small children including a pair of twins. You have to find that right person who's capable of taking them and handling them and ultimately being able to afford to do that because it's expensive. To go away and pay a nanny $10 an hour for an entire weekend and to sleep overnight is going to cost you more than the vacation.

"You have to be pretty strong in your marriage because it's very, very trying."

Even going out to go for dinner and getting a babysitter for the night is going to cost you $200. Most people can't afford that, especially when your husband has given up his full-time job. It's nice when they talk in these magazines about "make sure you make time for you and your husband," you just have to realize you need to do it in a different way. Rent a movie, order in Chinese with wine. And if that doesn't become the romance of the night, because you're both too exhausted, you both have to accept that. It's very hard to get in the mood when you're so tired. You still have to do that every once in a while. You have to acknowledge it because everybody has needs, not just sexual needs, but physical needs. Cuddling, holding and whatnot and talking about it from time to time. You have to be pretty strong in your marriage because it's very trying on the marriage. Very, very trying. 

I know a couple with three kids, the oldest 10 and the youngest 5. I've always thought of them as the ideal family, but one day the father said, "For five years my wife and I would high-five each other in the hallway and that was the extent of our contact." 

Exactly! You have to be mature enough to recognize that. Part of me feels blessed that I'm almost 40 years old and had the twins when I was 38. I wasn't a 24-year-old. I don't think I would have had the maturity. I'd have been like, "Don't you love me anymore, how come we're not having a sexual relationship anymore?" It requires a level of maturity to really understand that it has an impact on the marriage. We both know, though, that this isn't forever. The kids are getting older.

My brother and his fiancée came over to watch the kids and we got to go to a wedding. We had a drink each, had appetizers, sat next to each other. We look at each other and say, "Who're you?" He looked really good, he had his hair cut, had his suit on. I got an opportunity to admire my husband. To look at each other as a couple without someone hanging off my leg. I don't think people are really honest about that.

I was reading an article in Canadian Family last night. It was a whole section about loving your body after you give birth. I was like, "That's a whole 'nother story. Let's talk about stretch marks when you're having twins!" The article talked about trying to make time for sex during the day. I kind of giggled at that. I said, "That's ok if you have a single child and your baby naps from 1-3 and it's a Saturday. But what happens when you have a 4-year-old and twin 18 month olds?" There's no napping going on - well there's still napping going on on the weekends because by the time Saturday comes - well we squabble about who's getting up first and who gets the afternoon naps. We still, at 18 months swap naps! Even my older son says, "Is daddy napping?" We just know in order for us to function we still have to sleep. That might be part and parcel because we're not 28. We're not bouncing back as quickly. 

I would guess, no matter how young you are, as parents, you still want to nap under those circumstances. What about your older son, Adam. You mentioned he wasn't all that thrilled about getting two siblings. Can you talk about him and his impressions of his brothers, how he's handled his new circumstances? 

Adam is the apple of our eye. He's a bright little boy, energetic, as most little boys are. Very social very gregarious, loves attention – kind of like his mother. He struggled with the birth of these little boys. His first reaction was avoidance. Even to this day he still wonders if they're moving out. He said to me the other day, "When're they moving out to their own home?" "Adam, they're not, they're here to stay."

How he manifested his dissatisfaction was a regression in potty training, which was not pleasant because my entire year of 2007 was the year of poop. Changing 2 poopy pants of twins, then the poopy underpants of a 3-year-old that refused to go back into diapers was worse than combining the poopy diapers of twins. He'd only just trained himself at week three, then he was good for about 4 months, then... poop hit the fan! [laughs]

Every day, that's how he controlled us. That’s how he got attention around the pooping of the underpants. His excuse was, "It just slipped out.” But it slipped out every day and it was just torture for Paul and me. We tried every tip and trick, we tried praising him if he kept them dry, we tried going back to the Smarty Jar. Everything. We did everything to no avail. It did not work out until about 3 months ago.

He will be five in January. We were concerned he would be the child who went to kindergarten smelling like poo. There's always one in the classroom and it's going to be ours. We were terrified we were going to be sending this 4 1/2 year old to junior kindergarten still pooping his pants. It was the only way he could control us. 

Was there a milestone that got him out of pooping his pants? 

We don't really know what it was. I think it was maturity. I think he just started feeling better about himself. I was able to give him more attention. We got him swimming lessons. I was stronger and more able to spend time with him; I think he really resented that. Shortly thereafter I started working on his responsibility chart to reinforce staying clean and dry instead of asking him to stay clean and dry we decided to include one of the things on his chart as having a poo.

"Parents will laugh when they hear this because it's all about the poo."

Parents will laugh when they hear this because it's all about the poo. We started to reward him for using the potty instead of asking him to keep his pants clean and dry. If he could do that he got a star and if he gets five stars at the end of the day he gets a happy face token and gets to pick something from the surprise jar.  

Do you think he's fine with having siblings now? 

Nope! [laughs] He doesn't like that they steal his toys. He throws a tantrum when they wake up from their nap: "They're up!" He'll just start bawling so we'll send him to his room. He has been aggressive with hitting them behind our backs. He gets a happy-face token removed from his reward chart for hitting. Yesterday he lost three in a row because he punched me in the leg three times so - rip rip rip - three tokens off. He has really struggled. He's not an aggressive child, because we always told him since he was a very young child that hands are for hugs, hands aren't for hitting. He's just really struggled. 

I think part of his acting out is he’s bored. It's very hard to do everything together. We spend a lot of time at the park. His life is still dictated around the twins' nap schedule and their eating schedule. I think we're going to see a whole new boy again. 

During the first few months, particularly after he started regressing, was there someone at home that was designated as Adam's minder? 

Adam's minder was the television. That's the one guilty pleasure. Lots of parents say, "My child will only watch one hour a day." I said to Paul, "We're breaking some serious records here in the 'most hours watched by a 3 year old in a week' category." You feel pretty guilty about it. Fortunately, we still had him registered in nursery school, so he was going there three times a week. My mother-in-law would take him to the park. But he watched too much TV and it was just part of the survival mode. Not too happy about that situation. We let him watch appropriate television, but he watched more than he should have, but it's what we had to do to cope. We just did the very best that we could.

Will sibling harmony come to Adam and his brothers? (photo courtesy of Lee-Ann Charszewski)

Lee-Ann, thanks so much for your time and thoughts. Best wishes to you and your family, and congratulations on the forthcoming birth of your next child!

 

Update: Lee-Ann gave birth to her fourth child, a girl, in early February 2010. Mom and daughter are working through the early-day challenges of sleep deprivation and breastfeeding. We're awaiting comments from the brothers.