too much holding?

[Dovesong]

DH's sister, Beth had her baby 2 weeks ago. Specific details are fuzzy, but basically, her baby wasn't moving and she had an emergency C-section. The baby was born on 8/13. She had fluid in her lungs and her abdomen was distended. She was transferred from from the hospital of birth to a second hospital. They then sent her to Dupont in DE for emergency surgery to removed a twisted/perferated section of intestine. They did not reattach the intestine sections yet - currently has them outside her body with an illiostomy. She is no longer on the vent or IV. She is not gaining weight because of not having enough intestine to absorb it. I was in PA this past week to offer support and it broke my heart. The nurses are telling Beth that she should hold the baby only limited amounts because she is working so hard to gain weight. "It is stressful to be held and she needs to be in the isolette to be warmer." FYI, they are no longer using the heat lamp. Beth is depressed and it helps when she can hold her, but she is desperate for baby to gain weight and listens to the nurses. My mom and other nurse friends I have say this sounds silly. It is certainly counterintuitive to me. Do you have any research about holding preemies and how it might improve weight or body heat or decrease stress? I told the nurses that this was different from anything I had ever heard and said I would love to read the research that they have. They did not know what to say. BTW, Beth is pumping and baby is getting breast milk, but they have just added powder to it to increase calories.
What are your thoughts on this? Can you hold a preemie too much? How much is too much? She is barely holding her at all - just for feedings.
Also, what books do you recommend that specifically address this? I am thinking Dr. Sears. Anything else? A lot of what I read says to hold the baby, but it does not say for how long or what contraindications to look for.
Also, When Beth was holding her, she had her hand on her head. When she lifted her hand, the baby put it back! Doesn't that say a lot?
BTW, baby is 18 1/2 inches long. Birth weight was 5 lb, 8 oz, but included extra fluid.
Thanks for any thoughts.
Dovesong

[buckysprplmonkey]

I don't know of any reserach, but I've got a 2 week old 28 weeker (so he's 30 weeks gestation right now). He's a superstar, healthwise. Hardly needed the vent and had the apgars of a full termer (in fact better than one of his full term sisters). Even he tends to get really stressed if I hold him too long. We've found that one half hour to 45 min kangaroo session is about all he can handle before he starts desaturating or having bradys. And he can't handle having other visitors when we're doing it either. Yesterday, my MIL and oldest DD arrived while we were kangarooing and as soon as they got there (and started talking to him- they are both chatty to say the least), he started desaturating. Some babies just get overstimulated easily, even full termers, but especially preemies.

As for the isolette and temperature, though. I know Levi's temp is always better for several hours after being kangarooed and he has the most trouble when he hasn't been out for a while.

I'd definately get the Dr. Sears' Premature Baby Book. We have it and it's WONDERFUL! The hospital we're at also loaned us one by Ludington-Hoe and Golant called "Kangaroo Care." It is also very good.

HTH!

[irangel]

There are indeed times when a baby is too sick to be held and the stress of getting out of the isolette and being settled onto someone's chest just cause the baby irritation. That being said, how does the baby react to being held by mom? Is she content, do her vitals stabilize? If that's the case then there should be no reason for mom to limit how much she holds the baby. When my daughter was in the NICU there were several times when she was too critical to hold. Just touching her would cause her heart rate to shoot through the roof and her saturations to fall. But there were other times when she was seemingly too ill and nothing else was working so the doctors would ask me to hold her and see if that helped.

[Dovesong]

Thank you. I personally have not seen any signs of stress in this baby from being held, but I only saw her 3 times. Also, when she was held by mom, her blood pressure was the best it has ever been. (the nurses just ignored this by saying that her blood pressure is no longer the issue.)
After reading the sticky on "what we wish they knew", I need to discern whether I am being too pushy. I will buy her a book or two, because she has asked. It just breaks my heart to see mom getting depressed, but refraing from holding just because the nurse says so. It would have been easier for me if the nurse could have quoted some research, but she just had this blank stare. (I know this is not about me and am trying to figure out when to butt out and when to speak my mind. I think my SIL knows I am slow to speak my mind.) So any thoughts about this would be appreciated as well.
Dovesong

[aris99]

Hi,

I had a lot of nurses care for my dd as she was in the NICU for 3 mos. Some of them were laid back and would let me kangaroo whenever I was there. Others didn't want to take the time because it meant their lunch breaks would be shortened (no judgement from me on this because I know how tight their scheds were). What I considered most important was how my dd handled kangarooing. If this is your sister in law's only child and she can spend long hrs at the NICU I would ask the Dr on call (not the nurses) whether the baby was healthy enough to tolerate being held. Then I would insist (gently) on holding the baby.

However, if as in my case, your sister in law has other kids or can't spend very long at a time in the NICU I wouldn't be as insistent. Taking my dd from the incubator and putting her back was a jolt to her and if I was only going to be there for an hr I felt it was better for my dd to hold her hand or just watch her breathing. Each case is so different and I think babies "speak" for themselves. If their vitals improve w/kangarooing this indicates the baby is tolerating it and benefiting from it. If vitals become more unstable then maybe give the baby a day or 2 and try again.

I am so sorry for your sister in law...the NICU period can be an extremely depressing time. I hope she has good support....you are a very caring person she is lucky for that!

[Amys1st]

We could not hold Maggie (born at 24 weeks 6 days) for at least a month. They are much too fragile at that point etc. But after we got to hold her when she was around 30 weeks or so, sometimes it was too much for her and she would desat or brady as others have said. Once she was closer to full term, it was fine but I can understand babies in the preemie state can be tramatized by holding esp if there are medical complications to boot. As someone who has BTDT, it really sucks for the parents and tears your heart out but it gets better.

Also - the Premature Baby Book by Dr Sears is great for babies born AFTER 28 weeks. His micro info is way way outdated and will only scare the pants off micro preemie parents.

[momoftinyhayden]

We all know what she's going through so you came to the right place.

In our case we were not allowed to hold Hayden until he was off CPAP, then we were allowed to hold Hayden once a day for only a few minutes at first.... yes if a baby is not in the isolet and trying to keep up their body temperature they are burning caleries, which they need to gain weight. So therefore the nurse is correct there.

After Hayden was a little older we were able to hold him twice a day for 30 minutes. He was wrapped up in like 5 blankets but we could hold him. The stronger he got the more we could hold him, it just takes a bit of time.

I sat by his isolet almost all day long, with breaks here and there to use the bathroom and grab something quick to eat. But when i couldn't hold him I went and got some word search books and did them while he slept. Hayden was my first preemie and the IV's and all that kinda freaked me out a bit. There were times when his heart rate and saturation level would drop when he was held, others he did wonderful. It all depends on how they feel that day i think.
They know when mom and dad are there, even in the isolet they can hear your voice.

Oh yeah have her get a snoodle, she can take it home, sleep with it for a few nights, then take it back to the hospital, it will have her scent on it, They will put it in the isolet with the baby.

I think Hayden was a little over 3 pounds when we got to hold him the first time.