In this article, we discuss what to expect in the NICU. Having your baby admitted the Neonatal Intensive Care Unit (NICU) is not something any new mom would choose. And yet for some this is the road that they will inadvertently be placed on. Perhaps you are still pregnant and have developed a complication that may lead to your baby being admitted to NICU. Or perhaps your baby has just been born and is admitted already.
The NICU is a daunting place at first, and most new parents feel overwhelmed by all the monitors, lines and machines. Oh, dear NICU mommy, it is ok to feel scared and overwhelmed. My own baby was admitted to NICU so I truly understand. I remember walking into the NICU for the first time, with absolutely no idea what to expect and no understanding of the “NICU language”.
In writing this blog for new NICU mommies I hope to help you cope with this frightening situation. Here are some guidelines to help you interpret the NICU language and also what to expect in the NICU.
Please note before reading further
There are many reasons why babies are admitted to NICU. Being born too early is the most common reason, but there will also be babies who experienced complications during the birth process, were born with an infection, had mild breathing difficulties or who have congenital abnormalities.
Although some little ones may be very ill, many others are simply there to help them overcome some small glitches. This article offers some general information from the point of view of a mother who has gone through the experience and who truly understands what to expect in the NICU. But the care you receive will obviously be unique to your baby’s situation. Speak to your paediatrician or the NICU nursing sister if there are things you still don’t understand or need guidance on.
Here’s what to expect in the NICU
Arriving in the NICU:
Babies in NICUs are very vulnerable to infection, and all units have strict hygiene protocols. You will have to wash and sanitize your hands before entering and should sanitize at any time before touching baby. If you are experiencing any cold and flu symptoms at all you should discuss it with the nursing sister, and should considering wearing a face mask.
If your baby is very sick you may possibly not be able to hold your baby initially. This is obviously heartbreaking for a new mom.
Premature babies born at 24 – 28 weeks
At this stage, your baby will be very thin, with fragile red skin covered with downy hair (lanugo). His head will look large, he will have soft skull bones, and a small face with a pointed chin and eyes fused shut. At this point it is difficult to truly know what to expect in the NICU, as these little ones face many different challenges. You must know that baby is going to be there for a long time, and you should take especially good care of yourself.
Premature babies born at 29 – 34 weeks
These little ones will still be quite thin, and their skins will appear slightly translucent. They are still covered in downy hair. In girls, you may see tiny nipples. He may move quite vigorously and grasp your finger and may be able to suck or lick, but he probably won’t be ready yet to feed on his own.
Premature babies born at 35 – 37 weeks
By this stage, your baby will be much more robust and will look more like what you’d expect a term baby to look like. He may still be quite thin, with some hair, and he may still need extra help with feeding and breathing and staying warm.
Understanding the machines and equipment
Your baby will be in an incubator or under and overhead warmer for the first days or weeks of his life. This is to keep his body temperature stable.
Depending on what medical support baby needs, there may also be:
- A ventilator to help with breathing
- Machines which give measured amounts of fluids and medicines to baby through tubes going into their veins
- Various monitors attached to baby to measure temperature, heart rate, breathing and the amount of oxygen in his blood
- Special cooling beds to help reduce brain injury in babies who have had a difficult birth
All of this technology and machinery keep baby comfortable and allows the medical personnel to care for them without unnecessarily handling them. This because they will grow best in an environment as similar as possible as mommy’s womb, which was dark, less noisy and without constant disturbance.
The monitors have alarms that will let medical staff know immediately when baby needs extra care. The alarms may go off a lot, which can scare mom. Usually, it just means that the probe lost contact or that baby was moving at the time, but the nursing sister will keep an eye.
Other large machines are brought into the NICU when they’re needed. These include machines to:
- Take x-rays and ultrasounds
- Monitor brain function
- Give babies phototherapy for jaundice
Ideally, a NICU should be a calm place, with nurses and doctors quietly looking after the babies and other specialists coming in and out. Cell phones are not allowed, and conversation should be muted.
Feeding babies in NICU
Most babies will have an infusion (drip) to provide them with fluids. If baby is not yet able to feed intravenous nutrition may also be given. Straight after birth, this drip will be inserted into the naval or umbilicus, using the blood vessels that connected baby to mom’s placenta in the womb. Later this drip will be inserted into other veins in babies’ arms or scalp.
As soon as possible baby will be put onto oral feedings, preferably breast milk. Having a baby in the NICU usually means you can’t nurse right away, and you would need to start expressing breast milk as soon as possible to stimulate your milk supply and to provide baby with colostrum for early feeds. These may be given through a syringe or through a feeding tube that goes via the nose into baby’s tummy. If baby cannot feed yet this colostrum can be frozen until he is ready.
Itis important to note that breastfeeding is crucial for a premature baby. Drinking formula milk puts them at risk of various medical complications. Initially, you can express by hand, but within 2-3 days you will need the correct breast pump and extra support with expressing. Visit www.allthingsbreastfeeding.co.za for some guidance and support specifically aimed at South African moms.
Your doctor will prescribe a medication to help stimulate your milk supply, but you should know that frequent expressing and proper breast emptying are the main factors involved in insuring milk production.
ALSO READ: How to boost your milk supply
Feeling involved and connecting with your baby in the NICU
Giving birth to a premature baby can be incredibly stressful and it’s easy to feel disconnected. Remember that you are baby’s mom, and that you play an incredibly important role in also helping them through this experience. It is natural to feel like the nurses are taking over. A mother’s instinct is to provide and care for her newborn baby. In the NICU this might not always be possible.
The NICU staff will give you the schedule of when they will change baby’s nappy and feed baby. Try to be there to feed (hold the feeding tube) and/or change your babies’ nappy.
Ask the nurse to show you how to reconnect the pulse oximeter as it can easily fall off.
Read a book or sing to your baby so that baby can hear your voice. You can keep a cloth close your body and then leave it with baby when you are not there so that he can smell you.
Do as much skin-to-skin with your baby as soon as possible. Studies have shown that skin to skin is not just amazing for bonding, but also improves milk supply and has MANY other advantages for premature babies.
- It helps them cope with stress
- More stable heart rate
- It regulates their body temperature
- It improves the nervous system functioning
- More stable sleep patterns
- Better cognitive control
- Regulates heart rate and respiration
- Reduces post-natal depression in mom
- Improves weight gain
Acknowledge your emotions
It’s ok to allow yourself to cry, laugh, scream and be angry – no emotion is right or wrong. Talk to your friends or join a NICU support group where other mothers can share their stories and support you during this difficult time. Mommies who have been through this experience themselves truly understand how overwhelming it can be.
Take care of yourself
The saying goes “you can’t pour from an empty cup’’. So take care of yourself. Make time for a warm bath or shower, eat healthy and comforting food, drink enough fluids, and rest, rest, rest as much as you can! NICU admission can range from 1-2 days, to several months, depending on the reason for admission. You are in this for the long haul, and you will need the strength and energy to see it through. Burning out won’t help anyone. This is especially challenging if you have other children at home.
The last word
The NICU journey is a step-by-step process, many forward and many backward. But witnessing the determination of a premature baby fighting for life with each breath they take is life-changing for parents and those around them!
You are strong and you will get through this. For most it will just take some perseverance. Sometimes a miracle is needed. Luckily the NICU staff will tell you that they see miracles every day!