Preemie Baby Rights

[micah_mae_]

Hi everyone! Well I went into preterm labor last Thursday and was stuck in the hospital (I HATE hospitals!) until last night. I'm now on Procardia to keep labor from starting up again and I'm supposed to take it until 35 weeks. I got the steroid shots to help Corbin's lungs mature quickly and ultrasound shows him being as big as a 34-weeker. He wasn't bothered by the contractions at all! His heart rate stayed normal the whole time.
So now my problem is this...I was planning a birth center birth with a midwife. If I have him at 35 weeks, I can't have him in the birth center and I have to have him in the hospital. I know that that is the best thing for a baby born before 37 weeks.
However...if he is born at 35 weeks, breathes fine and on his own, eats well and has no other medical issues. Can I refuse letting them take him to the NICU or nursery for "observation"? If so, will they call CPS or something? Keep in mind that I will also be refusing most other "routine" procedures (bath, PKU test, hep B vac, vit k, eye goop, etc.). I just want to have my baby, make sure he's ok, and go home! How much trouble can I expect?

[Sandstress]

I'm sorry you're facing a preterm birth. As I found out, it's often a time to readjust expectations. I don't know anything about your specific situation other that what you've just posted, but I do know that 35 weekers are still "preemies" and they can have serious problems, rapidly, and after being "fine." I would advise letting the neonatologists "do their thing" when it comes to your LO's health. You can still be an advocate for him in the NICU- breastfeeding, kangaroo care, etc, and it might not be that long of a stay, considering he is so close to term!

[buckysprplmonkey]

I agree with the PP. Preemies of any gestation can have big problems fast and really need to be observed. It's a big adjustment and you have to allow yourself to mourn the loss of the experience you planned, but it is what's best for baby. I lost a second birth center birth to an emergency cesarean (baby was feet first and we had a placental infection) and a NICU stay. We've still been able to breastfeed, kangaroo and waive circumcision, but we had a wildly different experience than what we'd expected and had with our last baby. He probably won't have a long stay, being so close to term, but it's worth letting the neonatalogists do their job and make sure he's solid before taking him home.

As for them calling child services, it probably depends on the state you're in, but I would imagine that's probably something that they would be allowed to call child services for.

[sparklett]

I have to agree with all of the PPs. It is so very hard to have to let go of everything you hoped for, but at 35 weeks, your babe will need to be monitored a bit. You can be a proactive part of the situation by asking to tour the NICU ahead of time, talking to the neonatologists or nurses and expressly mentioning your desire to breastfeed and kangaroo, and outlining your wishes about care in regards to vaccinations, eye goop, etc. I know how badly you will want your baby to be with you, but at 35 weeks, it's so much better to err on the side of caution. Even 35 weekers can be prone to apnea, bradycardia, desats, slow-to-feed, and infections, and many of these things might not come up right away. I know 35 weeks seems to be so close to term, but that age is still considered preemie for a reason.

Hugs mama! Please let us know how things turn out.

[mrsfru]

My 35 weeker is now 5.5 weeks old. We refused Hep B vax and bath, w/no problems, could have refused vit K (chose not to, b/c I was on blood thinners, baby was a preemie, and born by c-section), and accepted erythromycin (by law in our state anyways). Observation/nursery time isn't mandatory b/c your baby will be 35 weeks...it would be b/c it's a stupid hospital "policy" based on staffing issues!!! We almost got around that at our hospital, however, ds was born w/pnuemonia and low blood sugar and had to go to NICU for help w/breathing and an IV. Some 35 weekers go straight to rooming in w/mom and then home like a full term baby, others do not. It will just depend on how your baby does at birth. FWIW, there was a ped and neonatal nurse at ds's delivery, so they checked him carefully in the OR. If he had been fine, he would have stayed w/me.

hths best wishes!

mrsfru

[angie7]

I agree with the pp. A 35 weeker can have major complications and I think it is best to have them observed in the NICU. You can still deny everything that you said you are, but to be safe, it is best to have him checked out. You would hate to take him home against medical advice and something awful happened that could have been prevented.

I learned with my preemie twins that everything changes when you have a preemie. I wanted a natural, vaginal birth, WRONG! I got an emergency c-section, we almost lost my baby a. I didn't want the use of binky's, no forumla, etc. WRONG again! I was not able to produce enough milk so they had to supplement, and they were very little (30 weekers) that the binky calmed them so I allowed it. I did deny the hep B vax but chose to get the vit K since they were so early and brain bleeds are common (luckily they didn't have any!)

and I hope your LO stays put as long as possible!

[GooeyRN]

I agree 35 weekers can be fine one minute, and crashing the next. *I* would stay for observation. Hopefully you can hit 36 weeks when there is much less risk!

[sbrinton]

I would second what everyone has said. Although it is hard to watch the NICU team take your mostly healthy, almost full-term baby out of your arms, it is important. I was in a very similar situation with my son Micah. I had been dealing with preterm labor and my doctors took me off medication at 34 weeks. He was born at 35 weeks and a few days.

While he did not have any major complications, he was right on that line. Many babies born at 35 weeks have trouble nursing. Infection is more common. Many need some help with breathing in the first days. Others have low blood sugar and need an IV. Our son had fluid in his lungs that meant he couldn't breastfeed right away. Premies get jaundiced more easily, get tired easily, get overwhelmed easily... Sometimes the hardest thing for a 35 weeker can be finding a car seat that is small enough for baby to drive home safely!

My best advice would be to ask your doctor if you could continue the procardia through 36 weeks. This is a low-risk medicine. If you are willing to take it easy for a few more weeks, the doctors could certainly work with you to try to prevent birth a little longer. Normally my midwives will not stop labor after 34 weeks, but this is also up to the parents.

When I was 6cm dilated but my water had not broken, they gave me the choice whether to continue in labor or whether to try to stop it with IV meds for a few more days. At that point, I had been on bed rest since 23 weeks and I was ready to be done, and thankfully Micah did well, but those first hours were really stressful and I definitely second guessed my decision to go ahead with labor.

[ernalala]

First of all I must say that I live in Turkey so things may go differently here than in the US. Most 'modern' births here take place in a hospital environment and are (strongly) medicalised, but mothers and their babies are usually sent home after 1 day or a few hours (depending on the hospital) after an uncomplicated VB and 2 days after an uncomplicated CB.

I was suffering from preterm labour, was under medication for contractions and babies' lungs but still had a (3 week postponed) preterm birth at 34w5d. My baby had to go to NICU care immediately since the birth ended in a vacuum operated birth. After a few hours of close observation he was brought to my room. He was a fine, strong healthy newborn that would go home with me in the morning. He was with us all night and nursing fine. However, things went differently since the next morning he had major difficulty nursing, they checked on him and he 'd developed severe jaundice so we were told he had to go into NICU care again. In the first days he also developed a urinary tract infection. He had a total of 10 NICU stay days in his first 12 days, meaning that he came home twice and was sent back twice too. That's equally hard as having him in the hospital for a full 12 days, or even harder emotionally, considering he was 'taken' from us three times, not just once. On the other hand, we had had the opportunity to have him home three nights in his very first days of life, which has been so great and a blessing to all of us and has been great for trying to life bf and bonding.

My second baby was not preterm but had similar issues in the first days/week after birth so also needed NICU care. The story is very similar to that of our first baby.

I would not want to recommend you to keep your (even preterm starting from 34w) in hospital if he's doing fine and considered strong enough to go home. But IF you take him home, you should be very attentive and know which signals mean taking him to the hospital again for a check-up since any newborn with difficulties may need (urgent!) treatment at some point, and preterm infants are more susceptible for complications.
Also take into consideration that visitors should better not come around until your baby is somewhat older and stronger and definitely not when they're suffering a cold.
If you cannot have your child with you at home, it'd be better to accept that and make the best of it all wishing he/she could soon come home to you. I know I've been feeling very useful pumping my breast milk at home and while visting in hospital (was not allowed to self-feed) every 2/3 hours to provide for my baby! That really empowered me a lot. We've been always very positive about it when our babies were in NICU, I mean we tried not to worry and to be convinced he was in the best medical care he needed, even while knowing he was missing all of our tender loving parental care because of that, it really helped us get through it.

I hope you can guard of further preterm labour until your child is ripe enough to be born. Success! It must also be very hard for you physically, so take care.

[Amys1st]

Originally Posted by angie7

I agree with the pp. A 35 weeker can have major complications and I think it is best to have them observed in the NICU. You can still deny everything that you said you are, but to be safe, it is best to have him checked out. You would hate to take him home against medical advice and something awful happened that could have been prevented.

I learned with my preemie twins that everything changes when you have a preemie. I wanted a natural, vaginal birth, WRONG! I got an emergency c-section, we almost lost my baby a. I didn't want the use of binky's, no forumla, etc. WRONG again! I was not able to produce enough milk so they had to supplement, and they were very little (30 weekers) that the binky calmed them so I allowed it. I did deny the hep B vax but chose to get the vit K since they were so early and brain bleeds are common (luckily they didn't have any!)
!

Wow this could be my birth story except I had just one baby. Maggie was a 24 weeker and had issues w apnea, feeding etc until she was well past 37 weeks. Its better to be safe than sorry. I also mourned not having a natural birth like I did for my first. But I will take that over not having my beautiful Maggie.
and I hope your LO stays put as long as possible

[mommylovesra]

((Hugs)) Hopefully you will get far enough along where it will not be an issue. FWIW though some babies that early have problems my 35 weeker got to come home from the hospital with me. He only had to spend one night in the step down unit and roomed in the rest of the time. I did have an emergency c-section so we stayed 3 days not sure if he would have been ready to go home immediately with out being checked over first. He did have to pass a car seat test too. My 34 weeker only stayed 1 week. The biggest things at that stage are usually eating and body temp. My advice would be to glue yourself to your little one's bedside and make every attempt at establishing nursing and it will get him home faster. You might have to give in on some things like antibiotics to rule out sepsis and bottle feeding when you are not there in the middle of the night. If they insist on measuring intake have them weigh before and after feeding. I hope you get to avoid it all. It is not nearly as terrible as when a baby has to stay for weeks or months but it is still hard I know and traumatic for mom.

[alicia9178]

Well...my 35 weeker is a bouncing crazy 4 year old now. We were in the hospital for about 20 hours after her birth and then went home. It is all dependent on the baby. I was lucky and she was great...but as a nurse there is a common phrase we say...."Never trust a 35-weeker". I would keep a positive mindset and just flow with what you get. You still can decline any of the vax stuff, eye goop, PKU...anything you want...I would make it known to all of your nurses. Just focus on enjoying the expereince and remember that this birth will never happen again and you cannot re-do is as much as it might now meet your expectations and just enjoy it. This is your baby's introduction to the world and no matter what it will be a special experience!!!
Alicia

[mistymama]

I had ds at 34 weeks. I'd been having contractions all day and calling my dr, I knew I was in labor but no one would believe me. Then my water broke. Whole 'nother story.

He was a big 34 weeker, 6lb 6oz. He seemed fine at first, but after a little bit had trouble breathing and ended up being under an oxygen hood for about 8 hours before he was able to keep his levels up on his own.

I know how hard it is to not hold your baby right away, etc .. but sometimes preemies do need that extra observation. I would have had no way of knowing his oxygen levels were low on my own, kwim?



I'm so sorry you are going through this. As someone who has BTDT, I would also suggest preparing to educate yourself as much as possible on preemies and breastfeeding issues. It took my son nearly 6 weeks to feed properly. He had no sucking reflex, an awful latch and no one knew enough to help me. It was not a very fun time, I was pumping, trying to get him to latch and feeding him with a syrenge so he wouldn't get nipple confusion.

He did eventually latch and bf, and is a BIG, healthy almost 6 year old. I wish you the very best Mama.

[Khourtniey]

35 weeks is my comfort zone.. I would refuse to let them take him. You can watch him for signs of distress and take him if need be.

FWIW though I refused and even had written out in my birth plan what to do and what not to do and even talked to the neonates and told them what not to do... They went behind my back and did things that I told them NOT to do.

[sbrinton]

How is it going? Will your doctors or midwives work with you to try to delay labor a few more weeks?

[momoftinyhayden]

My son was born at 30 weeks, he was small, had some breathing problems, but started out on CPAP. He was in the NICU for 15 days then moved to the intermediant unit, where he did well for several weeks, he just had to learn how to suck, swallow and breath at the same time. All of a sudden after 5 weeks of being in the interm unit he got very sick, he had to have 2 blood transfusions in 3 days.

It all depends on your baby if they need the extra care from the NICU. I am not sure about where you live but if a doctor here tells you the baby needs to be in the NICU and you refuse, they do call Child Protective Services... they consider it neglect. Some states are more easy going than others, but we live in a Common Wealth State and they are more particular than other states for some reason.

I know here preterm babies have to be up to at least 6 pounds before they are allowed to go home, plus they must pass the carseat test and have to be taking all of their feedings by bottle.

I would recommend listening to the doctor, if they say the baby needs to be in the NICU then listen, doctors don't send them there if they don't have to. It's better to have your baby stay in the hospital a few extra days and be sure they are ok, than bring them home and have something go wrong.


I had 6 of the steroid shots to help develop my son's lungs, 2 shots right when i was put in the hospital and then 4 more a week later. They helped a great deal but he still needed to be on CPAP after his birth, and they had to put medication in his lungs to help them expand.