My baby will be in the NICU- could use some guidance

[coffeegirl]

I'm 34 weeks pregnant now with my first baby. I am a methadone maintenance pain patient, so my daughter will most likely be born with some opiate dependence and withdrawl. For anyone who doesn't know, this is called neonatal abstinance syndrome (NAS).

We don't know at this point how severe the NAS will be. And there's actually about a 30% chance that she won't have it at all. We won't know until she's born. So she'll spend at least 5 days in the NICU to start with while they determine if she's experiencing NAS. If she is, then they'll do more testing to determine the severity and then she'll be weaned off a controlled dose of morphine so that she won't have to suffer through withdrawls. Babies born in this situation who have NAS are usually in the hospital for anywhere from 5 days up to 2 months. Obviously we're praying hard for the former.

Anyhow...sorry this is so long, I just wanted to get the explanations out of the way first. As I said this is my first baby, and I'm unsure what the NICU experience will be like. (I have looked through some of the articles linked in the sticky on top of this forum.) There is no NICU in my town unfortunately, so I'll have to give birth at a hospital about 45 minutes away. I don't drive, so my mom or other family will be driving me. But I'm really hoping I'll be able to actually stay at the hospital with my daughter as many nights as I can. Not sure what the normal procedures are for that, or how I can find out?

If they don't let me room in the entire time, do y'all who have BTDT have any advice or tips on what I can do to make sure I'm spending as much time as possible with my baby and giving her everything I can of myself, considering the circumstances?

TIA for reading, and for any replies...

[LaughingHyena]

Have you or will you be able to visit the NICU where your little one is going to be? So many of the policies vary from one hospital to another so it's really helpful to be able to ask your hospital.

Things I would like to have know before hand
Are there any restrictions on when you can visit the unit ?
In my NICU we were allowed to be on the unit at any time of day or night, with the exception of about an hour in the morning when the doctors came round. Even then we were usually able to stay while they were talking about DD but had to leave when the other babies were being discussed.

Are there restrictions on who can visit?

Is there a parents room, somewhere you can heat up food or just go for a break?

How do they handle breastfeeding? In theory our NICU was supportive but they also fed to a shedule (which I understand as they had a lot of mouths to feed). But knowing that I was able to time my visits before DDs feeds so she always got a chance to breastfeed before being topped up via a feeding tube. I think changing my visiting pattern by 1/2 hour made a huge difference to our breastfeeding relationship but it was not something the nurses suggested.

[RaeEllen]

I'm a neonatologist, so these questions come from that perspective (as well as from my perspective as a parent)

Can you get a prenatal consult with one of the neonatologists? There are many questions that will have very different answers depending on specific unit policy. Getting information and even advocating for your own preferences is sometimes easier before the baby is born.

You will obviously be inpatient at the hospital for at least 2 days. Can the baby stay in your room? Babies with NAS often stay with mom before medication is needed. (Obviously, I can't speak for that NICU's policies, but it certainly isn't a given that the baby needs to be separated from you immediately) If the baby needs to be observed longer than 2 days, is there a way for you to board and have the baby with you?

Who will be the babies doctor? Will it initially be a pediatrician? Or will they go right over to the neonatologist's care? What is the doctor's thoughts about breastfeeding? (There are still some doctors who are wary about using breastmilk from moms on methadone. I'm not supporting this, just warning you.) If there is any issue with breastmilk, making sure you have copies of your HIV, Hepatitis (B and C), and drug screening results can be very helpful.

Will the baby go directly on morphine? Do they have any experience with phenobarbitol? (Babies can not go home until they are off morphine. They can go home on phenbarbitol. But different NICU's will have different medication protocols. Often babies on phenobarbitol still need morphine. They just may need less)

Finally, discuss what measures will be taken to help the baby with withdrawl prior to using medication. Babies that get to be in dark, quiet rooms, that get to be swaddled and comforted by sucking will do better. Babies in the middle of loud NICU's that can not be held and just have pacifiers that fall out of thier mouths will score worse (and get medication sooner) just because they are getting more agitated.

Hope this is helpful

[justmama]

i don't know but knowing that you have nicu time in front of you sucks. So I couldn't read and not respond. Best of luck to you.

[shannonsmommy]

I just wanted to chime in and wish you the best with your baby, as well as her stay in the hospital. You might want to check with your hospital on their policy in regards to you staying with her. My daughter ended up being discharged from the hospital with me, but her doctors had some concerns initially and thought she might need to stay in the NICU to gain weight and lie under the bili lights. They told us that they usually had empty postpartum rooms and that as long as they weren't needed for another mother, we could spend the night there as long as our daughter was hospitalized. Obviously, I would no longer receive care from the nurses and meals wouldn't be brought to the room, but it was a great comfort to know that option was there for my husband and I if need be. If I were you I'd check with the hospital you'll be birthing at to find out if they allow something like this, since I'm not sure all hospitals do. All the best to you and your little one!

[poppan]

I was allowed to stay in a postpartum room (past my 4 days paid for by insurance--I had a c-section) as long as they didn't need it for a paying patient. No meals and no nurses but they still came by to empty the trash and sweep up a bit. I was lucky and they didn't need the room for a whole week after I was formally discharged. After that I still had twin babies in the NICU so I asked what the other options were. At my hospital they had some rooms squirreled away here and there--many of them were like broom closets!--and I was assigned one of those. It was gross and hadn't been cleaned in ages and I had to use the public bathrooms and shower 7 floors down on the pedi floor, but it was a room and it was onsite, so I took it. When DD was discharged a few days later, I could not stand the thought of her also being in the broom closet, so I took her home and commuted the 45 minutes each way every day to visit/nurse DS.

Other parents I met in the NICU were from hours away--it was a level IV NICU and they were all the transport cases from other places in the state. They were set up in nearby hotels by social workers and even got meal vouchers and things like that, but I think they were under certain income guidelines.

At my NICU I could be there as much as I wanted, except between 7-7:30am and 7-7:30pm, that was the nurse shift change and everyone had to be out. When I was still in various rooms in the hospital I spent all day there, but slept nights by myself except when they called me to go nurse (I asked them to). Good luck I hope the hospital works with you, at mine I feel they really tried to accommodate nursing mothers.

[CherylMorrissette]

In our NICU, babies who are on a withdrawal protocol are assessed for signs of withdrawal every few hours. We don't usually start to see high "abstinence scores" until about the second day of life, which is why in our hospital, babies are kept with their moms unless they start to show higher scores. Being separated from mom is a stressor that can increase scores, so definitely look for a hospital that will let you be with your baby for as long as possible.

Things that docs and nurses will watch for include tremors, sweating and high temperature, loose stools (especially with a bad diaper rash), rapid breathing, excessive sucking, hyperactive reflexes, tense posture, and frequent waking or crying. If your baby starts to show enough of these symptoms to score high, then he'll be given phenobarb or morphine to help ease his withdrawal. The dose will gradually be increased until the scores decrease, and then the dose will be gradually weaned down.

Depending on the severity of his withdrawal, it could be a short NICU stay or a long one. To ease his course, make sure he's kept in a quiet, dark environment with minimal stimulation. You should be able to do all of the normal NICU bonding techniques with your baby. Maintain a calm demeanor while you're there - babies definitely pick up on their caregivers stress levels!

If you run into any trouble with breastfeeding, here's a copy of the American Academy of Pediatrics policy on methadone and breastfeeding - it's definitely recommended!

:-)
Cheryl

[mamaflutter]

Mama I'm srry u have to deal with all of this but at least u know what to expect. With my 4yr old we had no idea wed be spending 7 days in the nicu. With her my midwife found us an extra room so we coud stay close to her and breast feed once she was allowed to try. Same deal as every one said no nursing care or food but they did give us vouchers for the caffiteria and a parking pass. With my daughter who came early at 33 weeks july 2nd we were able to stay at the ronald mcdonald house. It was truely a blessing it was so nice they have snacks and things comfy beds a family room with a tv and internet acess. It was the only way I was able to exclusively breastfeed my becca. I will tell u that info about the ronald mcdonald house was not offered but I asked about staying in a room. I also asked about meal vouchers which I got. And the social worker got me clothes so I could change. We were brought by ambulance to louisville and had no car or a way to get things from home. So don't be afraid to ask for anything u might be suprised how much they don't tell u. My other advice is the nicu nurses r ur friend they will spend more time with your baby in the hospital ten even u. Let them help u ask them as many questions as u need to even the ones u think r dumb ask anyway! Pick your battles stick to ur gund on the core of your belifes but sometimes u might have to bend a bit. There will b a nurse or 2 u just can't stand iknow there was for me but I just sucked it up and waited till shift change. There will be nurses u love that will go to bat 4 u and help as much as they can take it. We had 1 alyssa she was great. My daughter had probs gaining and maintaining her weight alyssa called on her day off to sugest pumping a few ounces b4 I feed her so she could get more hind milk and hopefully gaim quicker because she knew how important breastfeeding was to me.
I wish u luck and hopefully baby will be great and won't have to stay too long. I'm fresh off my 10 day stay so anything u might want to know feel free to message me. Oh and one other tip bring good hand lotion with you cuz scrubbing in like 10 tmes a day is super drying!

[Jrene]

Im so glad you posted this.

Im currently in a simular situation. I've been on percocet my whole pregnancy, but I've been slowly whinning off the 7.5/325 dose. I started at 6 a day and now at 2 a day. I was starting to feel stressed with the extra pain I was having and talked to my Pain Management dr about it. My blood pressure was high and I was swelling in my feet and hands. He didnt listen to my concerns and at my next OB/GYN visit I had all three signs of preeclampsia.. swelling, high blood pressure and protein in urine. I talked to my OB and asked if the stress of whining off the meds could have cause the preeclampsia. His reply was yes, it could.

After my 3 day stay in the hospital I called my Pain Mngmt Dr talked to the nurse explained what was going on and havent heard anything back from his office.

I want to do whats best for my baby. But Im affraid of pushing my body to hard could cause me to have a stroke with the preeclampsia. Im so torn about is the "right" thing to do.