Category Archives: Delivery

The Tiny Baby Blues

26 Tuesday Dec 2017

Posted by in babies, Delivery, Early Days, Parenthood, pregnancy, Uncategorized

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I met a family last week who had an extremely premature baby. I had two extremely premature babies, but this baby was so premature that I was reduced to saying, essentially, ‘oh, shit, that’s an early baby.’

I have been thinking about that family a lot since. They arrived at the NICU – our NICU – a couple months after we left and stayed for a long time, though they are home now. But I keep feeling regret for them – not that they spent four months with a baby in the hospital, though that sure sucks a lot – but that they left the hospital without the resources that they would have had if things had gone more smoothly. Its hard to make friends with other parents when your experience diverged so sharply from everyone else’s so early, and its hard to settle into a rhythm as a new parent when you feel alienated from everyone else and their robust, healthy, oxygen-free newborns.

When I was pregnant with my first child, my husband and I did a birth-prep class. We had been warned that the content was not especially useful (it wasn’t), but that there was a lot of value in meeting your classmates – classes are organised by neighbourhood, and we live in an extremely fertile area, so our classmates lived around the corner, down the road, up the street – we were extremely geographically concentrated. When one of the babies was born early, the father sent an email to all of us saying how nice it was to meet everyone and he hoped to see us again soon sometime.

We had a good laugh about that at our fourth annual birth-prep group holiday in October. We saw each other almost every day all summer, and are still in regular contact with virtually everyone in the group, which has swelled (with second and, in our case, third children) to 32 people.

My group are outliers; most people don’t end up taking regular vacations with their parenting classmates. But most people do leave the hospital with a roughly shared experience of birth and new parenthood. Plus a baby. Most people leave the hospital and take their child with them.

For NICU families, it isn’t like that. I found it relatively easy to leave my daughters behind, not because I’m a callous witch, but because they were clearly…not finished. They were in incubators and they clearly needed to be. I found it harder at the end, when we were in sight of a finish line that never seemed to get any closer, and the girls looked and acted like babies instead of fetuses.

Still, from the moment they were born, I thought they were perfect. I wanted to tell people about my gorgeous twin daughters as much as any other new parent. When I was two weeks postpartum, I took my son to a birthday party and people asked how I was. It was only as I watched their eyes widen that I realised I had to adjust my rhetoric a little. ‘I just gave birth to tiny, perfect, extremely premature babies!’ isn’t exactly cocktail fodder. No one knew what to say. I skipped the next preschool party.

Of course there are families in the NICU who are going through something similar to what you’re experiencing. When people ask if I made friends in the NICU, I say ‘well – Facebook friends.’ I did meet people whose acquaintance I value, but none of them live within a twenty mile radius. Catchment areas for Category III (most intensive) NICUs can be huge; there are only a few in the UK. There are always families coming and going, and there is a hierarchy. One woman took weeks to warm up to me, presumably because her kid was having a rough go and she didn’t want to deal with another baby having an easier time than hers.

So I’ve been thinking a lot about this family I met recently, who had four crummy months in the hospital only to find themselves starting from a different place than everyone else who has a baby the same age (actual or adjusted) after they got discharged. I’ve wondered what could be done to make it easier for them, and I’ve wondered what I could do without coming across as an overzealous weirdo. I haven’t come up with much so far.

 

 

Prematurity on TV: Black-ish Season Finale

10 Sunday Sep 2017

Posted by in Delivery, Early Days

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I’ve seen a few episodes of the American sitcom Black-ish, which will be returning for season4 on 3 October (in the US. in the UK, who knows? I saw the finale at 10 am in the morning on ITV. I think.).

Season 3 had centred on the late-in-life pregnancy of the female lead, Rainbow, and the finale gave a mostly-accurate depiction of a sudden, scary turn: she developed pre-eclampsia and delivered the baby two months early (so about 32 weeks gestation).

I wrote about prematurity as depicted by Pampers  a couple months ago – in general, I would say, pop culture doesn’t have much of a track record addressing prematurity. Which makes sense: prematurity is not telegenic. Preemies can be ugly or scary or just a bit too….fetal…to be comfortable to look at. They are tiny and fragile and hooked up to all sorts of crap.

Black-ish did a pretty great job with the maternity stuff; everything they said about pre-eclampsia was correct, and the parents’ fear and panic was pretty on point too. But then the show was stuck with a premature baby that they had to deal with, and that’s where I thought the show went off the rails a bit.

First of all, that baby was gorgeous. Small, but chubby. Not hooked up to any breathing apparatus. No long lines, or lines of any description. No incubator. Just a few monitoring devices so we knew this was Not a Normal Baby.

I mean, I understand. I thought Daphne was gorgeous straight out of the womb. In the first picture ever taken of her, she has one eye just cracked with Not Impressed expression that remains her trademark seven months later. Watching from the operating table, I saw the nurse hold up my tiny 2 lb baby and I knew that things couldn’t be that dire or they wouldn’t be hoisting her up like Simba for photo ops. But really, to the untrained eye, she looked pretty raw. I had that picture printed but my mother suggested I not send it to my grandmother. I look at it and think, ‘damn, my baby is a fighter’ but in retrospect I can see how other people would just react with alarm.

Preemies are alarming. But the show could easily have circumvented the need for a close-up by showing an incubator (also called an isolette), or by simply reporting on his condition. Instead, they made it look like the scary part was over. Anyone watching would see that baby and think ‘oh, that’s not so bad, he looks fine.’

I realise I am complaining about a sitcom, and I shouldn’t hold them to documentary standards, but the experience of having a premature baby doesn’t end a couple days postpartum. The fact that the girls were early is still very much with us seven months later (five months adjusted), and will likely stay with us forever, in the form of soft teeth of poor vision or attention or behavioural disorders. We are very lucky that the biggest thing they faced in the NICU was ‘smallness’ – they were just really, really tiny. Daphne was so small that, for a long time, she kept cutting off her own airway when she moved her head. She just didn’t have the strength/maturity not to.

September is NICU Awareness Month. The show originally aired this spring, but it seems fitting to me to talk about it now, after it ran in the UK. Most NICU babies are, in the grand scheme of things, Just Fine. But they are fine because they have the benefit of an incredible amount of care and support and science: they NEED incubators and long lines and various unpleasant, humming machines, and for a television show to skip that part of it – while demonstrating the very accurate fear and anxiety of the parents – is to do NICU babies, and neonatology in general, a disservice.

Boobs.

15 Thursday Jun 2017

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[Usual disclaimer about how I am not a medical professional, breast feeding peer supporter or anyone with any official knowledge about breastfeeding]


Its kind of lunacy to think that I can contribute anything much to the world of online breastfeeding resources when a. its extremely well-trod territory and b. my qualification is, I’ve done some breastfeeding. Both times I had a stressful start: with my first, mostly because of incompetence; the second time, there was that whole NICU thing.  But both times I gave birth, my baby had a nasal gastric tube. Theo had low blood sugar and, though he was full term, was tiny; he had a feeding tube put in directly after birth and spent an afternoon in Special Care. He was also born with an infection and was floppy and lethargic for the first 36 hours of his life, even by newborn standards.

Both times I was desperate to breastfeed. The first time I just couldn’t get the damn baby to latch. I ended up exclusively pumping after failing, every three hours, to get a latch, then dumping milk and formula down the NG tube into his stomach. The midwives didn’t believe me, but the whole depressing ritual – fail to latch, feed, pump, sterilise – took about two hours and forty minutes, leaving you with twenty minutes before it was time to start again. I have confirmed with other women: no matter how long the health professionals say it should take, it takes 2 hours, 40 minutes. For the first several days, no one bothered to tell me that you can pump on both sides simultaneously. Our hospital doled out single-breast packs (one bottle, one set of vacuum parts) and everyone on the ward shared a communal pool of hospital grade pumps.

On the third night, I called my husband, who was asleep at home, to act completely insane and accuse him of failing to support me in my attempts to breastfeed. I have no memory of what behaviour  of his set  me off, but I do remember that trying to get Theo on the boob had left me shrieking in frustration. I mean,  in the normal course of things, I’m not much of a shrieker.

Anyway. The thing that I originally wanted to impart is this: I have had three occasions where I have had kids on NG tubes and have had to introduce breastfeeding slowly, instead of doing the normal thing where you have a kid, put the baby on the  boob (or the bottle), call it a day and go home. Even if you do have a lot of success with breastfeeding (in which case, pin a rose on your nose) it can still be painful, time consuming, frustrating….my sister said she was glad she knows, from my experience, that feeding is not an easy and magical experience. And it seems obvious to me now, but three years ago I thought that I would have a baby and they would eat. I thought it was something I could prep for with classes and research. I was wrong.

That said, if you are in a situation similar to mine (especially if you have preemies) there are some things I recommend. First, it is important to be proactive, even if your child will not immediately be taking milk (ie if they are on liquid nutrition to start). You can start hand expressing immediately after birth, and – new in the last couple years – medela, the most common supplier of hospital-grade pumps, has created a ‘preemie initiate’ setting that stimulates the breast before hand expressing.

If you want to breastfeed, the best hing you can do is get after it. Milk yourself every three hours – the way a baby would if they were eating. Only expect a tiny amount at first – colostrum, the milk that comes right after birth, is meticulously collected in il syringes. But if it hurts or you aren’t getting any, ask for help: nurses, midwives and care assistants have experience milking new mums, and they’re probably better at it than you are. If your hospital is stressed for resources, ask for a lesson and have your partner help you collect it. It’s not dignified but…well…you get over it quickly. On my fourth day postpartum, I so get out one of the women who had helped me eke out my first drops and proudly showed her my freshly collected 35 mils. I actually got a little choked up – it was a mix of gratitude, pride, relief and Hormones.

Basically the biggest lesson – which I suspect is a theme – is advocate for yourself. Failing that, prep your partner and have them do it for you. There is no way to physically prepare for breastfeeding, so the best thing you can do if it doesn’t come naturally is ask for help – loudly and repeatedly if needed – and be patient with yourself.

And if, after all that, it doesn’t work out or you decide you actually kind of hate it, buy some formula and move on.