08 Nov Making the most of your baby’s Neonatal Intensive Care Unit (NICU) stay

By Anchen Verster – registered nurse and midwife, SA certified perinatal educator, mother of 4, including twins

A Neonatal Intensive Care Unit (NICU) stay might be furthest from your mind when you’re pregnant but it’s a reality that faces many new parents. Roughly 15 million babies are born prematurely worldwide per year according to the World Health Organization. One in every 10 babies is born prematurely in South Africa. A premature baby is one born before 37 weeks of pregnancy but full-term is 39 weeks or more for a single pregnancy so some babies born between 37 and 39 weeks may struggle to adjust to life outside the womb. Whether you’re expecting multiples and know you’ll have a few days or weeks in ICU or an ICU stay is totally unexpected it can be a very traumatic experience. Here are a few guidelines to help…

Start hand-expressing milk as soon as the birth is over…

In the past we used to give moms a few hours before asking for colostrum, but now we know that the sooner you start removing colostrum the more milk you are likely to have on day 3 or 4. Hand Expression is a technique you should learn before having your baby whether you know there will be an ICU stay or not. There are multiple online video clips that can also be helpful.

I find it useful to use a regular ointment or nipple ointment on your hand to lubricate – before starting to express – this also makes it more comfortable for your breast. After a caesarean you will need someone to help you collect the little drops of colostrum in a sterile syringe. Usually your partner will be on hand to do this. Once you are able to sit up it may be easier to hand express into a teaspoon and then suck it up into a syringe especially when you do not have help. I always tell moms to take a few medicine teaspoons (well cleaned) in a plastic bag or plastic container to hospital. Aim to hand-express at least 8 times in every 24 hours. I know there is a temptation to sleep the whole night but again research shows us that doing 2 hand expressions during the night hours can maximize the production. Your prolactin levels peak at night so removing colostrum or milk at night will maximize its milk producing effect. This might be difficult during the first night- particularly after a caesarean – but aim for at least two expressions in the nights to follow. The night would be counted from 10pm to 5am, thus one expression at 10pm and another during the night before 5am – round about 3am.

Once you have a few milliliters (1-3ml or even less can be normal with each expressing in the first 24 hours) in the syringe you can label it with your hospital sticker and take it to the NICU. Once your milk comes in you may want to use a breast pump but in the first days it is easier to hand express because the volumes of colostrum are small.

During expression your body releases Oxytocin, which is also known as the mothering hormone. This release may help to make you feel like you are more involved in your baby’s care and nurture – even though you are separated from her. Don’t be discouraged if you are not able to express colostrum in the first 24 hours but keep trying. Most hospitals will be able to put you in touch with a lactation consultant if the “getting going” is difficult.

Talk, Sing or Read to your Baby…

Some NICU’s will not allow you to hold or do skin-to-skin with your baby until he is more stable, but your baby wants contact with his parents because you are the ones he knows – your voice is familiar to him. Talk quietly in calm, low tones or even sing or hum a tune. Tell him how much you love him and can’t wait to hold him. Watch what happens to the heart monitor and oxygen saturation when you talk or sing to your baby. Many parents will notice how the measures improve when they do this and this gives them confidence to keep touching and singing or talking to their baby when he is awake.

Touch your baby…

Your baby may seem too fragile to touch, but she knows the deep pressure of growing inside your uterus and wants to feel close to you. Imagine what this deep pressure must have been like and allow your touch to mimic this by gently cupping her head or ‘containing’ her trunk with both your hands or providing a base with your hands on which her feet can press against. Keep in mind that stroking or tickling is too stimulating and will be stressful for your baby so the touching must be a continuous hold rather than rubbing or moving your hands in any way.

Any change of movement in your hands should be done very slowly to keep from over-stimulating your baby.

Help facilitate good positioning…

Going back to the womb analogy, your baby was curled up in a foetal position in the womb with the firm boundary of the uterus around her. She should have had a few more weeks of this deep pressure and safety so when she is lying in her incubation bed we want to mimic this safety and comfort as far as possible. “Nesting” is the word we use to describe the soft but firm boundaries we place around a baby to make her feel safe and confortable. She may be nursed at times on her stomach, which she will find very comfortable. Usually her legs will be pulled up in this position. She will also prefer having her hands near her face and mouth. Most parents remember ultra-sound pictures of their baby sucking their hand or fingers in utero. If she is swaddled at some point, hands at face applies to this position too.  

Skin-to-Skin… (Kangaroo Mother Care)

The research on the importance of spending extended time doing skin-to-skin with your baby is overwhelming. This means semi-lying or comfortable sitting with your baby in a nappy (with or without a beanie) against your chest and covered with a cotton blanket. The nursing staff will help you position your baby for optimal breathing and safety. Apart from stabilizing heart rate, temperature, respiratory rate and stress-hormone-release it awakens the baby’s senses to breastfeeding and maximizes the laying down of healthy nerve pathways in the brain, which are essential for healthy functioning. Some NICU’s promote skin-to-skin from early on while others are hesitant. Keep asking to do skin-to-skin. It is helpful to wear button up shirts or pajama’s to make it easier and allow you to feel less exposed. Ideally skin-to-skin contact should be for as many hours of the day and night as possible. His sense of smell is very sensitive and he will know your smell. Avoid wearing fragrances so that he can smell you and his senses won’t be overwhelmed by the perfume. 

Get involved in your baby’s care…

Helping to care for your baby will help you feel more involved and facilitate the bonding between you as parents and your baby. Do as much of the care as possible. You can do things like nappy changing, feeding with a cup or tube and bathing. If you are nervous because you are worried about the tubes ask the nurses how to do things like changing your baby’s nappy while protecting the baby’s airway and any tubes that may be in place. Remember slow, calm movements rather than fast and unexpected movements. It is important to try and keep these activities to your baby’s natural awake times.

Keep feeding times near or at the breast…

Once you are feeding your baby with a nasogastric or orogastric tube feed, allow your baby to lie against your breast with his mouth and nose as close to your nipple as possible. You can squeeze some colostrum or breast milk onto your nipple and allow your baby to smell and taste it while you are giving the tube feed. You will need extra hands to help – especially in the beginning. Feed times at or near the breast will help him associate being at the breast when his hunger is being satisfied and will help facilitate breastfeeding when he is ready. From 28 weeks a premature baby can suckle at the breast even though he may not be able to take in any milk. You can give him as much time as he likes suckling and tasting milk at the breast.

Express your feelings…

Because the birth may have been very traumatic for mom and dad or the ICU admission unexpected you may be feeling very emotional. Talk about how you feel to each other and to family or friends. Cry if you need to and this goes for dads too. It can be very overwhelming watching your little one and at the same time feeling helpless and unable to protect and comfort your baby. You may prefer to see a social worker or councillor to debrief after the traumatic time. It is okay to feel very overwhelmed or even angry or confused but it’s important that you talk through these feelings. Research shows that a large proportion of parents who have a baby in NICU (or previously had a baby there) suffer from symptoms of PTSD (Post Traumatic Stress Disorder). Its imperative that you find the support that you need through these stressful days. It might also be helpful to link in with a support group or if not available find a preemie group online. Some parents find this helpful while others are overwhelmed with the opinions and medical advice that you might be bombarded with. If you use this platform use it as a place to share what you are going through, but only if you personally find it beneficial. Sometimes just hearing that other parents have come through similar experiences can give you confidence and motivation to persevere. 

Ask questions, clarify what you hear…

A NICU is not a normal environment to spend time in. The staff that work there are used to all the machines and equipment but often forget that the environment can be very intimidating for parents. Ask as much as you need to. Our imagination is often worse than the reality so find out more about your baby’s condition. It may seem scary to ask but knowing will help you feel less scared and enable you to be more pro-active. When staff are explaining something about your baby or your environment, repeat back to them what you have heard so that you can be 100% sure you have the correct information.

Honour your baby’s sleep…

Sleep cycles are of utmost importance to your preemie’s brain development and ability to cope with their stressful environment. Her sleep will be most productive if she is able to sleep while doing skin-to-skin on mom or dads chest. This better sleep will also enable her to better interact with you when she is awake. Try not to disturb sleep cycles by waking your baby for tasks, rather wait until she wakes up. If your baby is sleeping skin-to-skin on your chest block out some of the light from her eyes with a blanket. You can even muffle sound by resting your hand over her ear.

Honour your own sleep, eat well and get some sunshine…

We all know that being well rested helps us to cope in stressful situations. Getting enough sleep even-though it is interrupted for pumping sessions will help you adjust to your situation and cope better.  Take turns with your partner to stay at the hospital while the other gets some rest. Try and pack a snack and healthy lunch in the morning to take to the hospital so that you’re not tempted to live off unhealthy tuck-shop food. Keep a water bottle close to stay well hydrated. Often the hours pass by when you are busy with your baby and you forget to drink fluids regularly. The hospital environment and air-conditioning can also be very drying. Pop outside once or twice a day to get the benefit of the suns rays. This will also help emotionally.

 Keep a journal…

Keep a journal of the ICU experience each day and an account of how you are feeling. This can be very cathartic. It will also be special to read in weeks or years to come when you can recount the challenges you went through as a family. In years to come your ‘teen prem’ may find it very special to read of the experience through your eyes and feelings.