Some questions

[chase_mommy]

My pregnancy has started going in a not so great direction and it looks like I will be delivering my baby soon. Probably no later than 2 weeks from now, he will be 34 weeks then but he can be taken sooner. He is also very small for his gestational age... 12th percentile.

Anyway, since this is all been sprung on me at once and I am now on bed rest in the hospital I am trying to get my ducks in a row.

I have two other children and they were both term babies... I know nothing about premature babies and I am starting to freak out that I may not be able to parent them and be with them (while in hospital) like the others.

Here are my concerns. How can I make sure they don't circumcise him? Telling them no, is this enough? I will be recovering from a c-sections and sadly wont be able to be with him all the time. This is really bothering me, I never let my other two out of my sight. Breastfeeding... how is this going to work? I have some colostrum but I know is not enough to sustain him now. Should I start supplements to build my supply right after birth? Can I prevent him from being on formula? I don't want to deal with nipple confusion. We don't vaccinate, how is this all going to come into play with a premature baby?

Any ideas, tips, suggestions or websites to check out? I am sorry this is disconnected but I am so sleep deprived. Every time I fall asleep his heart rate decels and they come running in and flipping me all around.

I am sure some of this needs to be posted in other forums too. I will try to get to that later, I just thought this would be the best place to start.

[SilverFish]

hi!

34 weeks is pretty good as things go... depending on the reasons for delivering sooner, your son could have very few problems. don't take their estimation of his size too seriously, it's very hard to accurately gauge his size in utero. at best, he will probably need some observation and feeding help.

anyway, knowing that he'll be premature in advance is really the best way to prepare... my daughter came very unexpectedly at 35wks (and we had planned a homebirth!) so i was completely unprepared for even the hospital, let alone a NICU stay. plus you're not a first time mom, so things like breastfeeding should hopefully come a little easier!

vaxing, circumcising and other newborn things should not be a problem. just make it clear what you don't want... if your baby is sick, they won't be doing unnecessary procedures on him anyway. don't mention vaxing (they don't do anything in the hospital ususally anyway!) just say what newborn procedures you don't want. i was even able to keep them from washing her right away. please come to terms with the fact that this won't be the birth you envisioned, it's in a hospital, things will be different, but stay strong on the things that are really important to you.

for me, that was kangaroo care and breastfeeding. i really wish i hadn't allowed myself to be bullied about breastfeeding. the NICU environment is NOT set up for exclusive breastfeeding and it was really hard not to get steamrolled by the nurses. i did of course pump, and we are now EBF, but it was a long hard road to get here. i didn't know what kangaroo care was before she was born, but having her against my skin was something i did instinctively, and i wish i'd known about the demonstrated benefits to give the nurses who kept telling me i was "overstimulating her"!!

the first thing i would do is get ahold of a lacation consultant and have her meet you at the hospital before you deliver, and shortly after. she can walk you through the challenges you might face breastfeeding a preemie, and if you can have her there during a consult with your OB, she can run interference with NICU policies instead of you having to do it while recovering. you are right, your colostrum will not be enough right at first... they will probably be pushing formula unless you have a source of breastmilk available. i came to terms with the formula use for the first couple days... after all, these are the situations for which formula was intended and actually useful! if you can get a donation, that would be the best thing, although i would check your NICU policies on donated BM. i wish more than anything that i had known to get an independent LC to help me through that NICU stay, instead of relying on the spotty at best knowledge of the nurses.

secondly, i would be preparing for a NICU stay of at least 2 weeks, perhaps more. that means that you will be at the hospital for at least 8 hours, probably more a day. you need food, rides, child care, help in the house... if you have a community that can help with this, ask for it, and be specific. don't try to stay at the hospital 24/7 though. you need sleep, and showers, and time with your other kids and home-cooked meals. try to find a schedule that works for you and stick to it as much as possible.

this doesn't mean he WILL be in the NICU for any more than a couple days, but prepare for the fact that he might need quite a bit of help.

thirdly, i'd be finding out as much as possible about your hospital policies and set-up. ask as many questions as you can. get a tour of the NICU and find out what kinds of things they allow and don't. get the number of the NICU and meet the nurses. find out about facilities for parents. how long will you stay in the hospital? is there a place to stay after you've been discharged as a patient?

anyway, on my top ten list of things for a NICU stay:

1. lactation consultant
2. big fluffy blanket, bathrobe and comfy cushions for kangaroo care
3. information about hospital policies
4. information on best practice for preemies (where it conflicts with hospital practice)
5. support network to provide drives to the hospital and meals
6. access to hospital grade pump at home
7. support network to take care of things at home
8. patience
9. more patience
10. care supplies for mom in the NICU (books, ipod, slippers, water bottle, snacks, toiletries etc)

[sparklett]

I'm sorry you're going through this and I really hope you're able to keep going for as long as possible.

They won't circ. him while in the NICU. You might want to remind them (frequently) not to retract the foreskin, though.

Have you been able to visit the NICU yet? You can can always ask for a tour. Sometimes it's helpful to know where your baby is going to be and what it might be like. At our NICU, the nurses had cameras and took pictures of those first moments so I could see. The photos were sad, but today they are amongst my most cherished possessions.

It is really important that you hook up with the lactation consultant ASAP. You'll need to start pumping right away and keep pumping for every 2-3 hours around the clock. You CAN breastfeed this baby!! Usually, the feeding will progress from TPN (food delivered directly into the umbilical stump), then tube feeding, then "nippling" with a bottle, then finally breastfeeding straight off the breast. It's different for each baby, though. After being fed with a bottle, it might be hard to switch to the breast, but it is possible.

Kangaroo care is key!

We found success in using nipple shields. We fought and fought to eliminate bottles completely and DS came home exclusively breastfed. It was hard as heck- DS was a 33 weeker and was in the NICU for 21 days. I really had to put up a fight to BF, but it worked in the end.

The Preemie Book by Dr. Sears is a good resource, especially for older preemies like yours. I also liked The Preemie Parent's Companion. I have both and you can have them, if you want them. Just send me a PM with your address.

If you want to chat more, please PM me. Good luck mama.

[guerrabug45]

I had premature rupture of membranes with my DS at 34.2 weeks. The NICU was a great surprise! As a mother of two you already know the value and importance of advocating for your own child! DO NOT let anyone talk you out of breastfeeding your baby. My son was intubated twice and had a feeding tube through his nose for a week, but the only substance that went through that tube was my milk. I pumped, pumped, pumped. When we finally did bring him home I had to wake him every 2.5 hours for a feeding, so that meant I set the alarm, pumped, then woke him, fed him, fell back asleep and started the cycle all over again. By one month of age, however he was completely off the bottle and on the breast ( I did use a shield for a few months).
As for the circ: tell anyone and everyone that you do not want him circumsised! That also goes for formula, everytime there was a shift change I told everyone I did not want him given formula and I did not want him cut!

He did not have any vacs at the hospital and our pediatrician said, "let this little guy get some meat on his bones before we start thinking about that."

Oh, kangaroo care! Huge benefits!

Also, be careful of antibiotics for your little one. Dosing preemies is not yet a sound science and an overdose can cause hearing loss. If they push it really get a risk analysis!

All of that being said, love your baby and trust everything will be o.k. My little 5.4 oz froggie baby is a most perfect 60 lb 4 foot six year old. He is absolutely amazing without any health issues! I on the other hand am completely scarred by the premie/NICU experience. Good luck and virtual hugs.

[chase_mommy]

Thank you SO much ladies!!!! You have no idea how much you all are helping me, I am so very much appreciative! This response my be choppy as I am exhausted and have only had 5 hours sleep in the past 2 days.

I am unable to tour the NICU unit because I am on strict bed rest and have to be monitored constantly. But, I looked through my high risk folder and found a 3 page handout about breastfeeding and NICU. They are VERY pro breastfeeding here. The head Pedi of the NICU came down today and talked to me and explained their procedures. He told me not to worry about formula... 'premature babies have no immune systems and need the antibodies from the breastmilk.' They have a huge freezer and storage containers and labels. There is already a hospital grade breast pump in my room. There is also a LC who is staffed and I will be able to see her whenever I need too and she will visit regardless after the birth. I plan on making a meeting with her soon. About circing... they dont do it here to premature babies. The Pedi said they are susceptible to so much they dont want to expose them to any more possible infections by making a wound. Thanks for the tip about 'No retraction'. I am going to print off a few bullets on a bright piece of paper about Circing, retracting and No formula and tape it to his isolet.

Thanks for all the tips. I will come back when I have more of a brain to use and respond to individual post a bit more. Once again, Thank you all so much!

[SilverFish]

i'm glad we could help a bit! i have to say, one of the very very few positives about being on bedrest in the hospital is that you do have the time now to come to terms with the change in circumstances and time to get to know the place where you might be spending a fair amount of time. it is really amazing that you get to meet the ped before your little guy arrives. even though you don't get to see the NICU, hearing it directly from the source about policies and procedures is very helpful.

about formula and colostrum in the first couple of days... will they not give anything but colostrum? i am still not clear on what's considered best practice for that. at my hospital, they gave colostrum topped up with formula to reach the amounts they wanted to give her. the reasoning was that a full-term baby is equipped to deal with transitioning to less food for a couple days until the milk comes in, but a preemie is expecting the full amount of calories they'd be getting via umbilical cord, so colostrum isn't enough. as soon as my milk came in, they only gave that.

[mama2toomany]

I just wanted to update, some may not know, but Chase_mommy delivered her baby today at 32 weeks.

Info here

http://www.mothering.com/discussions....php?t=1231697