Low Birth Weight

Mamas on Bedrest: What to Expect if Your Baby Arrives Early

November 4th, 2013
Newborn Vanessa

My Daughter one day old in the NICU

Mamas,

November is Prematurity Awareness Month and November 17th is World Prematurity Day. These times have been designated by the March of Dimes to raise awareness about the worldwide problem of preterm birth and infant prematurity. Each year 15 million babies worldwide are born too soon. In the United States alone, over 500,000 babies are born too soon annually. When a baby is born too soon, its risk of death before its first birthday is significantly increased. According to the March of Dimes, a premature baby dies every 30 seconds somewhere in the world. The March of Dimes is at the forefront to the battle with research and programs designed to help every baby “have its 39 weeks.” For more information on the scope of the problem, take a look at this very inforamtive infographic put together by the March Of Dimes. Please take a moment to learn about this very significant problem-one that likely disproportionately strikes Mamas on Bedrest. 

Now that we’ve addressed the statistics regarding preterm births, what exactly should mamas know? How many of you have had frank discussions with your obstetricians or midwives about what would happen if your baby were born too soon? In my case, the issue of having a premature infant was never brought up-despite the fact that I spotted and had some contractions early in my second trimester, had Braxton Hicks vs preterm contractions in my third trimester and finally delivered my daughter at 36 weeks and 6 days. Even though we were discussing putting me on bed rest, my OB never said to me, “If your baby were born today, we would expect_____”. I had no idea my child could end up in the NICU and I was completely blindsided when she was taken there. Likewise, I was ill equipped for seeing her all hooked up and with an IV in her little hand when I first saw her in the NICU. While I am completely in favor of trying to prevent preterm labor and prematurity, I think that parents should be educated about what to expect if their baby does in fact arrive too soon. And since the NICU is not on the hospital tour, and if your OB is like mine, they are not taking about a preterm birth (probably don’t want to jinx things!!), Here is what I think you need to know in the event your baby arrives early.

 

You won’t be rooming with your baby

Everyone kept telling me how awesome it was when you first have your baby and they put him/her to your breast. They talked about how you could hold them instantly and how you would room together. This is not the case if you have a premature infant. Most likely, the minute your baby is delivered, he/she will be whisked over to a warming bed and huddled over by a neonatal team. I was frantic because when my daughter was first born, she didn’t cry initially. They had to clear out her airway and tap on her little chest and soon she let out a wail. I didn’t get to hold my daughter when she was born. She was wafted by my face like a bouquet of flowers before being whisked to the nursery for more care. It was a full 12 hours before I held my little girl for the first time and that was because they were taking her by isolette up to the 9th floor to the NICU (My room was on the 2nd floor!). We never roomed together and she was eventually discharged 5 days after I was from the NICU.

Spend as much time as you can with your baby

I gave birth to my daughter at 8:03pm and finally got to “hang out with her” at 3pm the following day. I held her for the first time 12 hours after her birth, then she was taken to the NICU and I was told that I couldn’t see her or be with her because they were running tests. This made me crazy!!! Everyone kept telling me to relax and to get some rest (I had had a c-section) but all I could think about was my baby. I wanted her in MY arms!! I kept going to the nurses’ station and they kept telling me no, not now, it’s change of shift, etc….Finally at just before 3pm I shuffled my way down the hall to the elevators. My husband came runnning after me asking where I was going. “To see my baby!” I said. Everyone tried to hold me back, but I put my very achy foot down and said, “I am seeing my daughter now!” So a kind nurse got a wheelchair and up we went.  In the NICU, you must scrub as if in preparation for surgery because any germs could be lethal for many of the wee ones there. Also, avoid wearing extraneous clothing and jewelry like hats, dangling necklaces and earrings (this is more for guests, but just an FYI) and such which can carry unknown germs. Most NICU’s have lots of rockers, at least one beside every little bed, so plunk yourself down with your little one and stay as long as they will let you. I was fortunate in that my daughter was a “late phase preemie” meaning she was very near term. She weighed 5 lbs 3 oz an was never in an isolette in the NICU. So whenever I went into the NICU, I held her. For the very little ones, this may not be possible. But put your hands in those glove things and stroke your baby, talk to your baby and let them know you are near. This is critical for the little ones to be able to calm down and feel secure. They had all that womb-time hearing your voice and feeling your heartbeat. Do whatever you can to replicate that soothing environment including finding as quiet a space to spend with your baby as possible. Reducing the bells and whistles also helps your little one be calm and to self regulate their breathing, their temperature and to self soothe.

Remember, You are The Mama!

The NICU can be an intimidating place! All the machinery and the staff can be a bit overwhelming. You may feel like everyone knows more about your baby than you do, but YOU ARE THE MAMA!!! Take your rightful place at your baby’s side. Ask questions about tests being run, procedures being performed and make sure you know about any changes in your baby’s status. If you need to, keep your own little log of information in a notebook or on your phone/tablet. Be an active part of your babies care team because quite frankly, you are the

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Kangaroo Care with my daughter

As soon as you are able, practice kangaroo care with your baby. This is where your baby is wearing only a diaper and perhaps a little cap and is placed on your (or their daddy’s) bare chest. This helps the babies regulate their temperature, soothe from your touch, soothe from the sound of your voice, and soothe from the rhythm of your heartbeat.

Breastfeed As Soon As Possible

Breastmilk is the best food for a premature infant. Depending on how premature your baby is, you may not be able to breastfeed initially, or your milk may not be in. As soon as possible, get a hold of a breast pump and begin pumping. Even a few drops is beneficial for your baby. The more you pump, the sooner your milk will come in and the more milk you will make. If its availalable, have a consultation with a lactation consultant to get tips on maximizing your breastmilk production. If you cannot produce enough milk, know that you can request donor breast milk. Also, because premature infants need many more nutrients for growth and development than term infants, you may need to consider a breastmilk enhancement. Learn more about this here.

Decorate Your Baby’s Space

While your infant may not be able to see much beyond his/her isolette, it is very soothing to the family to decorate the baby’s space. Bring pictures of the family and allow older siblings to make pictures. Bring in a Name plate to hang over your baby’s bed. When allowed, bring in clothes and blankets from home to begin acclimating your baby to his/her home surroundings.

 

Having a preterm infant is not easy. By all accounts, I was extremely lucky in that my daughter only stayed in the NICU for 10 days. I know families whose infants are in the NICU for 60 and even 90 days. It’s not easy, but you can do it. Knowing what to expect is half the battle, so I hope these tips will help you feel more prepared. I don’t wish a preterm infant on anyone. But being blindsided as I was is no fun either. Take this information and tuck it away. Hopefully you’ll never need it, but if you do, you’ll know, at least in part, what to expect.

 

Mamas on Bedrest: Hold Your Baby Close

October 18th, 2013

002_02Holding your baby close is one of the best ways to help your newborn adapt to his/her new environment.

Regardless of whether your baby was delivered vaginally or via a cesarean section, the difference between the internal womb environment and the delivery suite (even in a birthing center or at home) is a dramatic shock to the wee one’s system. Consider this; in the womb, your baby has lived in a perfectly controlled environment. The temperature is constant. There is no stark florescent lighting. There is plenty of food. There is a steady sway of movement from mama, and a soothing rhythm of sound from mama’s heatbeat as well as from her voice. Your baby is safe, secure and content. Once born into the outside world, your baby has to contend with a vast drop in temperature and has to learn to maintain his/her own body temperature. Where breathing was once easy and facilitated by the placental connection with mama, babies now have to breathe completely on their own. The food supply via the umbilical cord ceases and babies have to learn to suck-either mama’s breast or a bottle-all while breathing, maintaining their body temperature and adapting to the myriad of sounds and lights now surrounding them. It’s as if our wee ones have been transported to another planet and in a sense, they have! And it’s really hard work for them to adapt.

As we said in our last post, “Mamas on Bedrest: No Crying It Out”, a baby’s only means of communication is to cry. As mamas (and dads), our job is to “hear the cry” and to discern what our babies need. For most new mamas, this is a steep learning curve. But the one thing that can help both you and your baby be successful during this time is skin to skin contact, “Kangaroo Care”, holding your baby close.

I wanted to bring this issue to light because I have heard countless people tell new mothers, “Put that baby down. You don’t want to spoil him/her!” Nothing could be further from the truth! Holding a newborn in your arms close to your body won’t spoil him/her. In fact, skin to skin contact or “Kangaroo Care” allows your baby to regulate his/her heartbeat, regulate their breathing, to calm down, maintain adequate body weight, sleep more soundly, self soothe, breastfeed more successfully and gain weight at an appropriate rate.

Kangaroo Care was first introduced in Columbia in the late 1970’s. Burdened with shortages of hospital staff and resources, Dr. Edgar Rey Sanabria began having mothers of low birth weight infants hold their babies on their chest between their breasts. The babies were wearing only diapers and the mothers were also bare chested. A blanket was placed across the infant and mama. In this way, mama’s body heat helped warm the baby, and whenever baby was hungry, baby could nurse. Dr. Sanabria found that babies who had skin to skin contact with their mothers (and fathers) had better temperature regulation, were more successful breastfeeders, gained weight and were able to sleep and self soothe better. This technique was soon prescribed for premature infants. Preemies who had lots of skin to skin contact progressed faster than premature infants who did not and were discharged sooner. The practice finally caught on in North America in the NICU’s. Despite all the medical technology, close contact with parents is still the best medicine for even the most fragile infants once they are stable enough to be held. Frequent Skin to Skin Contact (Kangaroo Care) is now endorsed by the March of Dimes, The American Academy of Pediatrics and The World Health Organization. Skin to Skin Contact is recommended for term infants as well.

Mamas, you can’t hold your baby too close or too much in those first newborn days. The more you hold your baby close, the more you allow your baby to adapt his/her internal environment (breathing, heartbeat and temperature) with his/her external environment (lights, sounds, clothing, etc..). Skin to skin contact promotes bonding and this is a very important reason for dads to get in on the act. Babies need to know who their dads are and they will connect by the feel of Dad’s skin, the warmth from Dad’s body, Dad’s heartbeat and Dad’s breathing rhythm. Skin to Skin contact enables Babies to  come to know Dad as “a safe and secure being”, someone who is also present to meet their needs and love them. This promotes and hastens the bonding process between dads and their babies, a bond that will carry all the way through a baby’s life!

If you baby is crabby or fussy and not hungry, wet, ill or otherwise in distress, try sitting Skin to Skin. Sit in a comfortable chair, strip your baby down to his/her diaper and place them on your bare chest. Add a slight rock and firm but gentle hand on their little back, they will settle down in no time!

 

Additional Reference:

Kangaroo Care. The Holden Newborn Intensive Care Unit, The University of Michigan Health System.

Mamas on Bedrest: Hypothyroidism in Pregnancy

June 19th, 2013

It’s video Wednesday! In today’s video blog, I answer the question,

“Should screening for hypothyroidism be a mandatory/routine part of prenatal testing?” 

In this video, I review the common causes of hypothyroidism in pregnancy, the effects of hypothyroidism on maternal health and on fetal growth and development. Personally, I think that prenatal screening for hypothyroidism should be a mandatory part of prenatal screening. It’s an inexpensive test, simple to do and yields pertinent information. While “evidence based medicine” doesn’t deem it cost effective, My personal opinion is that the potential consequences make these relatively inexpensive tests worthwhile.