How to help your baby thrive in the NICU

Intensive care sounds, well, intense, but it provides the best care for premature babies. Three neonatal nurses share tips for making your NICU stay the best experience.

PHOTO: CANADIAN PRESS

The risk of preterm labour and issues during delivery are much greater when you’re carrying multiples. If you’re carrying twins or triplets, you need to be prepared for the possibility that your babies will need to stay in a neonatal intensive care unit (NICU) for a few days or even weeks after they’re born. My twin daughters, Chloe and Claire, who were born at 37 weeks, spent their first two weeks there. The first time I saw them in their isolettes, I couldn’t hold them; I could only reach my hand inside the top of the incubator to touch their small hands. Seeing IV needles protruding from their hands and a feeding tube through their nostrils was terrifying, but the around-the-clock care from experienced nurses and doctors assured me that my girls were in the best possible hands.

My husband and I relied heavily on the support, guidance and expertise of our NICU team. In fact, we called the NICU the best baby boot camp ever: We learned more about baby care in those two weeks than at any prenatal class we attended. Whether your twins are born at 25 or 37 weeks, here’s a guide to help your babies thrive in the NICU and help you stay calm in the process.

Ask questions
As brand new parents, it’s overwhelming to suddenly find yourself in the NICU. You can throw all the basic stuff you learned in baby books out the window. Instead, you’re meeting with a revolving door of nurses, doctors, occupational therapists and physical therapists while trying not to worry about the various beeps coming from your babies’ monitors. For my husband and me, the first few days were scary, but every single staff member spoke to us with compassion, explaining in layman’s terms what was happening, why our daughters were there and what progress we needed to see before they could leave. “The most important thing is to ask questions, and no question is stupid,” says Mary Welch, an NICU nurse at Providence Saint Joseph Medical Center in Burbank, Calif. “We want every parent to feel that their babies are in good hands and make sure all of their questions are answered.”

Find out when feeding times and nursing rounds are (often every two or three hours) so that you can participate in diaper changes, bottle feedings and taking your babies’ temperatures. My husband and I asked the NICU nurses to show us how to do those routine procedures and, when we felt comfortable, we took over. Taking ownership of these tasks helped us connect with our daughters, who would otherwise be confined to their isolettes. Plus, with nurses by our sides, we learned the best techniques for burping, swaddling and bottle feeding (NICU nurses are swaddling ninjas who can expertly turn your baby into a burrito in seconds). When Chloe vomited after a feeding or when Claire ripped her feeding tube out, we had a trained professional there to assure us that everything would be OK—and it was.

What not to bring
Everything we packed in our labour bag (adorable onesies, cloth diapers, infant rattles) was pretty much useless in the NICU. The special care nursery is already stocked with disposable diapers, receiving blankets and bottles. With all of the tubes on their bodies, Chloe and Claire couldn’t wear onesies—it was easier for the nurses to keep them solely in diapers, and the incubator keeps them warmer than any onesie could. Since you’re at a hospital, you’ll want to leave one-of-a-kind baby items at home. “I always caution families against bringing anything with a high sentimental value,” says Martha Mason-Ward, an NICU nurse practitioner at Children’s Hospital of Eastern Ontario in Ottawa. “Things can accidentally end up in the laundry and be lost forever. Plus, if your baby has regular bloodwork, a special blanket might get stained. Use the hospital linens and save personal things for at home.” It’s also important to keep the twins’ incubators sterile. Plastic toys that can be sterilized are preferable to stuffed animals.

What to bring
The NICU won’t look like a beautifully decorated nursery, but reminders of home can make you feel slightly more normal, especially if your babies are in the NICU for several weeks. “I encourage families to bring small items to personalize the baby’s bed space,” says Mason-Ward. When our daughters were able to maintain their own body temperatures, the top lids of their incubators were opened so that they could wear clothes. We brought our favorite onesies for them to wear: Star Wars-inspired outfits emblazoned with “The force is strong with this one.” This motto kept us hopeful, even on tough days when feedings went awry. Keep in mind that NICU staff need access to your babies’ IVs and medical devices, so onesies with snaps on the shoulders or down the front are best.

Know your squad
Over the course of your twins’ stay, you’ll meet with dozens of medical professionals. Sometimes what one nurse might tell you will differ from what the next nurse on duty will tell you. “Communication can break down for so many reasons, which is why our families are encouraged to keep diaries,” says Mason-Ward. “Sometimes they ask if they can put a little note on their baby’s beds to communicate their personal wishes.” Write down who you’ve met and their suggestions and communicate your personal wishes about breastfeeding and general care.

Close contact
Since my twins were born at 37 weeks, I was able to hold them in my arms the next day. For preemies born at 25 weeks or earlier, your team will have a different approach because their bodies are too sensitive to touch. “Their central nervous systems are so immature, so any kind of noise, touch or light is much more exaggerated,” says Welch. “Babies at that gestational age respond better to a steady touch rather than petting because that’s more irritating to them.” Instead, Welch recommends a firm but gentle touch on the baby’s head or hand. Posting family photos around the incubators can help parents feel more connected to their little ones. Find out if caring cloths—a piece of fabric that you put in your shirt to pick up your scent, which the nurse then places in the isolette—can be used. Anything placed in the isolette must be professionally laundered to keep your baby’s environment sterile, though, so check first with your attending nurse.

Visiting hours
Because you’re spending most of your waking hours in the NICU, it can be hard to communicate with well-meaning friends and family who want to support you. If you need help with childcare for an older kid, dog walks for your pooch or meals dropped off (MealTrain.com is a great resource for scheduling meal deliveries), reach out to a close friend or relative who can handle those details while you’re away from home.

Parents and primary caregivers can visit 24-7, but additional guests may be limited by bed space and visiting hours. “There are visiting hours for extended family, but because it’s still intensive care, it’s important to clarify what the policies are with your institution,” says Mason-Ward. At Providence Saint Joseph Medical Center, there’s a webcam called NicView that allows parents and relatives to watch their babies 24 hours a day. “Sometimes grandparents live out of the country or the baby is born at another hospital and gets transferred to us and mom had surgery so she can’t come here until day three,” says Mason-Ward. The parents are given a passcode that they can access on their phones, iPads and computers.

Expect the unexpected
The best advice we received while in the NICU was to not have our hearts set on a specific date that our daughters would come home. One day, they would both have good feedings and then, the next morning, we’d find out that they threw up in the middle of the night. “Take it day by day,” says Jo-Ann Alfred, an NICU nurse at Sunnybrook Health Sciences Centre in Toronto. “If you have to stay one more day, don’t look at it as a setback.” One twin may be ready to leave, while the other needs more time, so you may need to plan for childcare. Before discharge, your twins will go through diagnostics, such as car seat tests, hearing tests and eye exams. When you finally have your babies at home, take a day or two alone without any visitors to appreciate having your twins all to yourselves after weeks of supervised care.

Pump it up  diagram of a breast pump
How to use a breast pump

Breastfeeding was challenging for me because my daughters had trouble latching. I relied on giving them pumped breast milk instead. “Pump around your baby’s feeding times because you want to maintain your milk production,” says Alfred. “We can give a small amount of breastmilk via feeding tube every couple of hours, so if your baby isn’t feeding from you, you can still give her a bit of milk.” I found that it was far easier to pump at the NICU, sandwiched between both of my girls in their incubators—being around them made the milk flow. Every tiny bit I could give them felt encouraging. When I pumped at home, I scrolled through photos of my girls to feel connected to them and to help my milk production.

Rest and recharge
Heading to the NICU all the time can be extremely exhausting, especially when your body is still healing postpartum. My husband and I live down the street from the NICU, so we would visit every three hours. By 11:30 p.m., I was too wiped to head back to the hospital, so I stayed home while my husband visited. “If a nurse tells you to get some rest, rest,” recommends Alfred. “A lot of parents burn out from being here. You need to go outside, take a night off or work in shifts with your partner to give each other time to rest. Trust that we’ve got your back. If you can’t leave overnight, take breaks throughout the day.”

When I had anxious moments in the NICU, I’d walk to the lactation room and see rows of pictures of NICU graduates: photos of preemies who were born at 22 weeks or weighed less than two pounds next to present-day photos of them as smiling toddlers. These strangers and their NICU babies gave me hope that my girls would grow, be healthy and someday leave the hospital.

Read more:
The NICU never leaves you
Life in the NICU: a case study in hope

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