Guest Blog: Raising a Premature Baby

Brecca is a mother of two children.  Her most recent child was a premature baby boy.  Below she discusses some of the questions she faced after having her premature baby.

The below is just opinions; please take it as such. It is a list of questions I had upon bringing my son home from the hospital, the answers I received and my own personal experiences. If you have questions about your own baby please ask nurses and doctors, use baby books and internet searches as references and then do what feels right for you and your baby. I am not a medical doctor nor am I a child care expert. I am a stay at home mother of a term baby and a premature baby.

So what happens when your premature bundle of joy has passed all their tests (maintains their body temperature, no longer randomly stops breathing, no longer randomly has stops of their heart, is able to eat by mouth, possibly meets a weight requirement and the car seat test) and is now ready to come home? When the news that my son was ready to come home came, I was overjoyed, however I was also scared. I already had a daughter so I didn’t have the new mom jitters, I knew what to expect with a newborn, but a preemie is a whole different story. Besides their small size, which can be intimidating, they come with a lot of different concerns and possible problems and I had so many questions.

Nurses in the neonatal intensive care unit (NICU) are great resources and have probably heard every question before so do not be scared to ask them as many questions as you can think of. I think I asked all 17 of the nurses at least three questions every day my son was in the NICU. In the beginning most of my questions were about his health, progression and when he could come home, but towards the last week when he started progressing by leaps and bounds my questions turned to how to care for him at home.

There are a lot of products specially geared for premature babies or babies who are small (under 6 pounds) but do you really need any of them?

I personally wouldn’t recommend buying anything special for you premature baby. Your baby may be small now but they won’t stay that way for very long. Also most hospitals will not release your baby until they are at least 5 pounds. My son was 5 pounds 2 ounces the day he came home.

Diapers : The hospital will send you home with small diapers which your little one will soon outgrow. Besides they can wear newborn diapers if you fold the top down.

 Bottles and formula :  The hospital will also send you home with small bottles, nipples and a month or so worth of formula specifically for a preterm baby (if you decided to formula feed).

*Car seat: I definitely wouldn’t waste my money on a car seat for smaller babies IF the hospital says the one you already have is good. The baby will have to pass a car seat test where they are put in their car seat (with the base) and monitored for an hour to make sure they can sit up well in it, their breathing doesn’t stop and their heart doesn’t stop. Plus I know I didn’t want to leave the house with my son for the first two weeks if I didn’t absolutely have to, though that was mainly due to not wanting to irritate his freshly circumcised penis; anything that puts pressure on him, like a car seat strap can cause irritation to the healing wound.

Clothes : I did buy a few articles of clothing for my son in preemie size. I didn’t have to buy him any of them, however once he started to be able to regulate his body temperature the nurses began to put him in clothes that the hospital had. I wanted him to have something from home to be able to wear so I bought, washed and brought in 2 sleep sacs, 5 onesies, 2 pairs of pants and a sleeper. Once he was home he outgrew that size within two weeks. I could have put him in newborn clothes, which would have been big on him and saved myself the money. 

One thing I would recommend getting is a head support pillow, especially if you plan on using a swing or vibrating seat for your baby. The swing we bought didn’t have any head/neck support or any padding that would hold them in place. We used it, probably a little longer than we needed to, until my son was 5 months by his actual birth date.

How long will he need the preemie formula?

Preemies need to be on a special formula containing 2 or more extra calories per ounce. It also contains extra vitamins and calcium. Just about every doctor will tell you that preemies need to stay on preemie formula for 6 months, I’ve even had one tell me 12 months. My son has had no problem putting weight on and catching up size wise (he is just shy of 6 months and wearing 9 month clothes) but is still drinking it due to the added calcium and vitamins.

If your premature baby stops eats, loses the sucking reflex or starts to lose weight seek MEDICAL HELP IMMEDIATELY.  

How often should I feed him? Should I continue to stick to the strict schedule that the hospital had established?

In the hospital, my son was fed every three hours whether he was crying or not. If babies began crying that they were hungry before their scheduled eating time nurses would try to calm them down with a pacifier and hold them off until it was time. I was told this was so all the babies would be on a set schedule. They would all eat every three hours. From right before noon until roughly 1pm all the nurses would go around feeding all the babies. It seemed kind of wrong to me not to feed a baby that was clearly hungry when they began crying but there wasn’t much I could do. This strict schedule also meant feeding babies when they possibly weren’t hungry. Although I don’t think this was the case most of the time in the NICU. Newborns eat every 2-4 hours and preemies use so much energy growing, regulating their own body temperatures and developing that I doubt any baby in there wasn’t hungry after three hours rolled around.

So should I stick to the schedule that has already been established for him once I got home?

The nurses in the NICU told me yes, I should feed him every three hours. So I constantly had an alarm set on my phone to go off every three hours. I was concerned for some dumb reason that he would be hungry and not realize it or not cry. Looking back now this was a stupid move. I was always a feed on demand type of mom and would a baby really not realize that they were hungy. I kept up the 3 hour feeding routine for 2 weeks before stopping and just feeding on demand. Some times I would end up waking him up to feed him so I was feeding him when he wasn’t hungry. I could’ve gotten more sleep and more importantly I could’ve had him tell me when he was hungry so I wasn’t overfeeding him had I done what felt right. Overeating became a problem for my son, by the time he was 4 months old he was eating 60 ounces a day and weighed close to 15 pounds! I think he had gotten used to always being uncomfortably full and was unhappy if he wasn’t, plus all that unnecessary eating had stretched his stomach out so he didn’t feel full until he had 9 plus ounces in his stomach. As a general rule of thumb, a formula fed baby should be eating their weight multiplied by 1.5 in ounces. So a 10 pound baby should be getting a 15 ounce intake daily.

When should I start him on cereals and baby foods?

For term babies the recommendation is to start between 4 and 6 months however I was concerned with my son’s gastrointestinal tract not being mature enough. He was a month and a half early but he had been eating, digesting, and expelling waste pretty well since he was born. He did have a bit of an issue when he first came home with expelling waste but it stopped once we switched him from the pre-made formula to the powdered kind you need to mix yourself. I decided to wait until he was 6 months old by his actual age, 4 and a half months by his adjusted age. I told the doctor that that was my plan and he seemed to think it was a good one. With my plan to start him on cereal then, I would be covered by the 4 to 6 month range. However I had to start him on cereal when he was 5 months old due to his overeating problem. I was very concerned with his weight gain and his high daily intake of formula. I was told to start him on food to try to curb his appetite and help with a possible acid reflux problem. He had absolutely no problems after introducing cereal and then baby food. His GI tract was mature enough to handle it and it worked in slowing down his formula intake.

I also had a lot of questions about his age and development. He should have been born in the end of August but was born in early July.

How old is my baby?

There are two ways to tell people how old your baby is, actual age and adjusted age. Actual age is how old your baby is from their birth and adjusted age is how old your baby would have been had they been born on their due date. In the beginning when people would ask how old my son was I would give them the long answer, his actual age but he was born 6.5 weeks early and then I’d give them his adjusted age. However after he was 3 months old I began just telling people his actual age. You will want to be sure to tell doctors your baby’s actual age and tell them how far along you were, in weeks, when the baby was born.

When will he hit his milestones?

With my first baby I was very on top of milestone ages. I knew at any time what age to expect certain milestones and was very proud when my daughter hit them early and concerned when she was late. However now I don’t pay much attention because I realized that hitting milestones early or late didn’t really matter, as long as your child is hitting them. My son 1^st rolled over from belly to back at 2 and a half months old, he smiled for the 1^st time at 3 and a half months, laughed at 4 months and is currently working on sitting up and rolling from back to belly at 6 months. He is on par with his actual age on some things and late with others but as long as your baby is progressing it shouldn’t really matter if they walk at 9 months or 12 months.

When will he catch up?

Most doctors agree that premature babies will catch up by roughly 2 years old both size wise and developmentally.

I hope my experiences are helpful and can give some comfort. It can be very intimidating bringing home such a small baby who was born too early. Just take it day by day and remember to do what feels right to you.

*As I've stated before the opinions of those who submit guest blogs are not necessarily the beliefs of JediMomTrix.  Brecca states that as long as the hospital states the car seat is okay, that it is not necessary to buy a smaller seat.  However, a lot of infant seats are only recommended for children starting at a weight of 8 lbs.  Also, buying an extra head support item that did not come with the car seat can become dangerous, because it may not be manufactured to fit the car seat you chose.  I recommend if you have a premature baby, to visit the website http://csftl.org/. The group Car Seats for the Littles is a group who are certified technicians who specialize in recommending car seats for children of all ages as well as additional items to help your child fit in the car seat safely.  They can recommend the perfect seat for your child's size, age, and the type of car you will be driving, to help ensure a perfect install so you are not putting your child in danger.  You can also visit their Facebook page https://www.facebook.com/CarSeatsForTheLittles, and post a picture of your install or ask any questions and hear from a certified technician almost immediately with suggestions.  I am not saying that Brecca did anything wrong, her car seat may have been completely appropriate for her baby, as well as the headrest.  I simply wanted to specify that not all car seats, and all head support items are compatible for each premature baby.  Thank you.

Guest blog: When Labor Veers From Your Birth Plan

Brecca is the mother of two.  Her oldest child is a girl, Kylie, and her youngest is a boy, Patrick.  Patrick was born 6 weeks prematurely.  Brecca writes about the difficulty of having a delivery that was unlike her birthing plan.  She will also be doing another guest blog about the difficulties of raising a premature child.  

Generally, women start to think about their birth plan halfway through their pregnancy. I normally don't feel comfortable with anything unless I have set, detailed plan. But with my pregnancies I went with the flow. I never formally wrote my plan down with either of my children nor was either very detailed. However, what few things I wanted, I was very sure of: I wanted to labor at home for as long as I could stand it, I didn't commit to an epidural nor rule it out, I wanted to wait and see how bad the pain was and most importantly, I did not want to be induced no matter how past due I was and I did not want to have a c-section. But I'm sure as everyone knows sometimes plans work out and sometimes they don't.

With my first baby, everything I wanted ending up working out. I labored at home for 4 hours, longer if you count the hour drive to the hospital and the half an hour wait on the side of the road due to a flat tire. I ended up having an epidural so I could rest since we were in the middle of moving to a new place and I hadn't been able to sleep much the previous week. My daughter was born vaginally after 12 hours of labor and 20 minutes of pushing. Everything went according to my very loose plan. 

However 2 and a half years later, the birth of my son wasn't what I was expecting or planning. My son was due at the end of August but he was born 6.5 weeks early in the beginning of July. With him, I had to be induced because both our lives were in danger. My blood pressure was dangerously high and I was so swollen everywhere that my parents and even my daughter didn't recognize me. 

Almost exactly a week prior to his birth, I was diagnosed with preeclampsia.  After a 36 hour stay at the hospital, doctors decided it was a mild case and sent me home. Even though I stayed off my feet and avoided salt, it didn't stay mild for long.  After a few days I was so swollen that not even my husband's shoes fit me.  I constantly felt exhausted and sore everywhere. I was terrified the whole week because I knew I had to keep him in there as long as I possibly could to give him a better chance of being born alive and healthy. Every day felt like I was juggling chainsaws, like one tiny thing could happen and everything would go very wrong. Every night felt like  a victory since I had made it another day and my son was still inside my womb. That week was the most stressful and longest week of my life.

On the morning of July 9th I woke up feeling the worst I had yet. I had a routine appointment in the afternoon and decided to wait a few extra hours and go to the appointment rather than going to the hospital. After the nurse recorded my weight she took my blood pressure, it was dangerously high. She kept taking it over and over again to make sure it was correct. After she kept getting the same numbers she left to inform my doctor.  I must have been alone in the exam room for 5 minutes but it felt like hours. I knew what my doctor would say before she even came in; I needed to go to the hospital and more likely than not have to be induced or have an emergency c-section. As soon as the doctor walked in the exam room I started crying hysterically, I was terrified. After she calmed me down as best she could, my husband who was watching our 2.5 year old in the waiting room was called back and told to take me directly to the hospital.

My husband dropped me off in the emergency room where I was promptly transported up to labor and delivery and hooked up to a magnesium drip to try to get my blood pressure under control. Once settled in, I began to text my husband everything I needed him to bring me from home while he arranged a babysitter for our daughter. Within an hour the doctor on call decided that I had to be induced.

 It wasn't part of my plan at all; however, I didn't care what had to happen as long as my son and I were going to be okay. Thankfully the week prior I had gotten a steroid shot to help my son's lungs so they didn't have to wait 24 hours to start an IV with pitocin. I only knew 3 things about having labor induced; the contractions were irregular and more painful, it lasted longer than naturally occurring labor and c-sections were more likely due to the length of labor or it not progressing. I was assured that my chances of a c-section were slim not only because I had given birth vaginally before and because my son would be small but also because I was already mildly contracting before they began the induction. The other two things I thought I knew turned out not to be true in my case.

The whole induction process wasn't nearly as bad as the horror stories I had heard. While my contractions were irregular they weren't very painful at all and after the pitocin was started I was only in labor for 18 hours. Eventually contractions did begin to hurt and I ended up having an epidural because of a recommendation from my mom. Her logic was that pain increases blood pressure and mine was too high even with the medicine to lower it, it seemed it would be safer for me to relieve the pain. However, I did experience the worst pain of my life during the birthing process of my son and it wasn't from something I expected.

Magnesium is a wonderful drug for lowering blood pressure however it has two nasty side effects. One of which is nausea. I did end up getting sick twice though I'm not sure if it was from magnesium or from being in labor. My main issue with the nausea side effect was that I wasn't allowed to eat. I know, during labor no one is really allowed to eat or drink but my intake restriction lasted for 24 hours after giving birth. I was starving and one wonderful nurse ended up sneaking me some water and crackers during my observation period. The other side effect was the headache. I had the worst headache of my life without any real relief for two days thanks to it. When I mentioned my headache I was told it wouldn't go away until after the magnesium was stopped and that wouldn't be until after I made it through my 24 hour supervision in labor and delivery after my son was born. The only things I could do to slightly lessen the pain was have the lights low and have one of those ice pack pads they give you postpartum on my eyes. I think I went through 20 of them and looked really stupid but at that point I really didn't care as long as something could help. The headache was by far the most painful part of my son's birth and his birth was both more painful and less painful than my daughter's.

After almost 18 hours of labour I was only 5 cms dilated and my doctor decided to break my water before she had to leave to preform a c-section on another woman. Little did anyone in that room know that she would be delivering my baby before her scheduled c-section. Once my water was broken I informed the doctor that I felt extreme pain and the urge to push, she didn't believe me until she checked me again. Within a few seconds of my water being broken I had gone from 5cms to 10cms, fully dilated. She told me that I had to wait to start pushing until the NICU doctors came in and were set up. The pain of progressing so quickly, not having the epidural adjusted accordingly and fighting the urge to push was by far worse than any aspect of my daughter's labor. However, it hurt a lot worse with my daughter while pushing and birthing her.  She was 7lbs 2oz and tore me in the birthing process. My son however, was 4lbs and 3oz and easily came out after 2 pushes.

Thankfully my son was born healthy even though he was only 33.5 weeks along. As soon as he entered the world he screamed which was the most beautiful sound my husband and I had ever heard, it meant his lungs were functional. Unfortunately I only got to see him for a few seconds before he was rushed to the NICU. He looked small but better than I was expecting. He didn't look sickly or like a skeleton. It would be another 3 days before I would get to see him again in person and hold him because I had a long recovery ahead of me.

I had to stay in the hospital for 5 days after he was born. I was still considered to be in a critical period for 24 hours because preeclampsia can still be dangerous after giving birth. After a day of more magnesium and constant supervision I was moved from labor and delivery to the maternity ward. It then took another few days to figure out the correct dosage of my blood pressure medication and to make sure I was stable enough to go home. The swelling, which caused me to put on roughly 20 pounds of water weight, went away pretty quickly once I returned home. I would wake up 5 to 10 pounds lighter than when I went to bed. The hardest part of my recovery was not being with my new baby right away and having to go home without him. But that's another story all together.

 I wish I hadn't believed all the horror stories I had heard about being induced because it caused me unnecessary stress. I was so scared that I would be in labor for 72 hours before having to have a c-section and be in horrible pain the entire time. But in my experience, being induced wasn't any better or worse than my daughter's birth, it was just different. My birth plan may not have gone the way I wanted it to go but I am so thankful that both my son and I are alive and healthy, so it doesn't matter that it didn't go exactly how I wanted it to go.

Stay tuned for Part 2 of Brecca's story...

*The views and opinions of guest bloggers are not necessarily the opinions of those at JediMomTrix.