Arrived too soon: An essential guide for parents with preemies
Dr Kishore Kumar says,"Prematurity is no one’s fault – certainly not the mother's fault."
Dr Kishore Kumar
Your miracle baby arrived earlier than you expected – maybe weeks or even months earlier, and now they are cared for in a Neonatal Intensive Care Unit (NICU). Babies who are born before 37 weeks of pregnancy term are called preterm or premature babies. Parents of such infants need to take extra care of the needs of their newborns as they are more sensitive to the environment. Preterm babies need more attention when it comes to regular activities like bathing and feeding.
Birth of a premature baby leaves many parents with too many questions seeking answers on your baby’s health and how will the baby grow, mature and develop in the coming days and months. Before we attempt to answer anything, as a practicing neonatologist, I would like to convey and share to all parents that, prematurity is no one’s fault – certainly not the mother’s fault. Most of the time – mothers keep feeling guilty when they are faced with prematurity. We need to offer and ensure enough moral support is given to new mothers for coping with this guilt – along with coping with the added uncertainty of survival or survival without deficits.
Frequently asked questions by parents at the birth of a premature baby
*When will he/she get to go home, and how are you going to cope with this unexpected situation?
*What kind of health problems will the baby have?
*What kind of survival rates will the baby have?
*Can we touch and see the baby immediately after the birth?
*What support will my baby need after the birth?
*Will my baby need to go to the NICU? How soon after birth and for how long?
*Will I or my partner be able to go to the NICU with our baby?
*When will I be able to hold my baby?
*Will my baby need any medications? Why? What will the medications do?
*Will my baby need any equipment? Why?
*Will my baby develop like other babies?
*Will I be able to breastfeed my baby?
Some common issues for premature babies include:
*problems in their digestive tract
Although it is not easy, it is very important to remain stress free. Parental interaction with the premature babies – more frequently including feeding babies with expressed breast milk – “connects” them and makes them feel they are caring for the baby and bonding is better. Hence most mothers were allowed 24/7 in most nurseries around the world and should be encouraged. More recently there have been concepts of In-NICU mom’s stay – Perinatal bonding – with the mother lying next to the baby’s incubator. This has been gaining momentum to encourage mother’s involvement with the babies – but this has its own issues – babies need to be not very critical and mothers need to be ready to stay in the NICU for the length of the stay (sometimes could be as long as 3 months for extreme premature babies) and so on.
Common conditions that occur in premature infants
*Respiratory Distress Syndrome (RDS) : This is related to baby’s immature lungs
*Chronic Lung Disease/Bronchopulmonary Dysplasia (BPD)
*Retinopathy of Prematurity (ROP)
*anemia of prematurity (a low red blood cell count)
Some handy tips for new parents
*Positive thoughts – avoid negative feelings and thoughts
*You are one in many and Prematurity is not your fault
*Choose to read about Prematurity and understand what’s going on
*You can also feed her as soon as your doctor says it’s OK. The nurses will instruct you on either breast-or bottle-feeding techniques, whichever is appropriate for the baby’s needs and your desires. Start expressing breast milk from day 1 – even few drops on day 1 is very useful
*Get Informed: Seek support from a lactation consultant, other mothers & support groups who have gone through this. Talk to the nurses in NICU, Talk to the doctor for any clarifications
*Pump Early, Often, and Well
*Spend Time With Your Baby: Use “Kangaroo care” wherever possible. It is a method of holding baby skin to skin with mom or another loved one, can help make breastfeeding easier for mom and baby.
If your newborn is too small or ill to breastfeed at first, or if a birth condition prevents the baby from breastfeeding directly, use a breast pump which is an effective way to express milk and establish and maintain an adequate milk supply.
Beginning as soon as possible after your baby’s birth, express your milk at regular intervals, at approximately the times when your baby would usually feed.
Aim to pump at least six to eight times a day; this provides nipple stimulation and encourages milk production. You should pump at regular intervals throughout the night for the first few weeks, and that encourages milk production. If you wake up in the morning and your breasts feel full, then it means that you are sleeping too long through the night.
Breast massage before and during the use of the pump has been shown to improve your milk flow and may even boost your milk production. To do this, make small, circular motions with your fingertips, starting at the outer edges of your breast near the chest wall, and slowly make your way toward the center. The massage should always be gentle to avoid producing friction on the skin surface or massaging so deeply that it causes pain.
Keep in mind that you will express only small amounts of colostrum at first, but this immune-boosting substance is extremely beneficial for your baby. Some mothers find that expressing the colostrum by hand massage into a small cup or spoon is easier than using an electric pump in the first few days. Hand expression into a cup also allows you to save each drop, instead of losing milk that is trapped within the tubing of the pump. Once your milk supply increases, the amount of milk you can express will probably fluctuate from day to day.
As a result, you will need to increase the number of times per day you express milk to maintain an optimal milk supply. These fluctuations are normal—just more easily observed when expressing milk than when breastfeeding. Once your baby begins breastfeeding, your milk production is likely to increase as direct breastfeeding is always more pleasurable than expressing the hormones that certainly help to increase the milk production. To maximize your milk production, try to get as much rest as possible, take your prescribed pain medication, drink adequate fluids, and minimize stress.
Direct breast feeding is possible after the baby reaches a corrected age of 34 or 35 weeks, a bit earlier in some babies.
Expressed breast milk is given by palada or a bottle once a baby is just over 32 weeks when sucking reflex comes in and gradually gets better before that your baby is fed your expressed milk by a tube inserted into their stomach.
After your baby is home from the hospital, you may need to keep using your breast pump until your baby is exclusively breastfeeding (actually nursing) and growing well without the need for any other supplemental feeds.
(The author is the Founder Chairman and Neonatologist, Cloudnine Group of Hospitals, Bengaluru. He is also a healthcare delivery graduate from Harvard Business School)
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