Your newborn is not in your arms — she’s over there. You may be overwhelmed by the number of machines and the noises they make, the beeping alarms, the bustle of people coming and going. You want to focus on your child, but for a time, you can only touch her spontaneously through an incubator porthole, and must wait for instructions about when you can hold or feed her. Doctors, nurse practitioners, and physician assistants visit and perform tests. You hear many terms you don’t understand. Amid all the flurry, you might well have trouble even keeping track of the names of the people in your tiny daughter’s medical team.
The range of intense reactions many parents experience may seem uniquely painful, from self-consciousness to gripping fear. It helps to know you’re not the only one. The American Academy of Pediatrics offers this list of emotions.
Self-consciousness. The unit is a public place, shared with other babies and their parents, and the staff. The nurses will be watching you when you interact with your baby to see any signs of stress. Other parents may be taking their cue from you. You expected to be home, with loved ones! But over time, the situation may feel less strange.
Anger. It’s not unusual to experience rage, which could focus on anyone nearby: the hospital staff, your husband, your family and friends, and even the baby. Your mind chatters with “They just don’t know what they’re doing,” “They just don’t understand,” “How can he go to work and just forget about the baby?,” “Why couldn’t you have waited for just a few more weeks?”
Coping with the situation is already a huge demand on your energy, and anger will drain you more, so it’s a gift to yourself to acknowledge rage and do your best to calm yourself.
Guilt. If a baby arrives too early or sick, mothers especially may obsess about every day of their pregnancy, second-guessing their choices and blaming themselves. This kind of analysis, which psychologists call rumination, can lead to depression. Try to talk out any guilt feelings and move on.
Sadness. You may feel cheated and sad that you didn’t have a “normal” childbirth that ended with your baby in your arms and home quickly. You may have planned the birth in detail, but the picture in your head didn’t come true.
Powerlessness. You didn’t expect to spend all this time in the hospital with other people in charge. To combat a feeling of powerlessness, take charge in the ways you can. Ask the nurses questions, provide breast milk, and manage your emotions.
Fear. Especially in the first hours, parents are frightened. You may fear that your newborn is seriously ill, and will become disabled or even die. You might worry that you won’t be able to care for her properly.
Mothers might fear that they are somehow to blame and that their own mothers or mothers-in-law or the baby’s father will be angry with them.
Most of the time, no one can say why a baby was born too early or sick, or assign blame, even if blame were helpful. Remember that the common problems treated in the NICU (neonatal intensive care unit) are not necessarily serious, and that hospitals have many methods to solve them.
Here are a few of the issues that can arise:
The fetus stores iron towards the end of a pregnancy, which make red blood cells after birth. A premature baby may lack iron and become anemic. Your baby’s doctors can give her iron supplements, drugs that spur red blood cell production, or a transfusion.
Some babies are born with breathing problems because their lungs haven’t fully developed or because of complications during the delivery, birth defects, and infections. Medicines and sometimes a respirator will help her breathe.
Some babies may take five to 10 second pauses in between breaths — an issue that most outgrow. Sensors on the baby's chest send information about her breathing and heart rate to a machine located near the incubator. An alarm beeps whenever a baby isn’t breathing. You’ll hear people referring to "A's and B's." If a baby stops breathing for 15 seconds or more, the interruptions are called “apnea.” A slow heart rate is called “bradycardia.” A nurse can stimulate breathing simply by touching the soles of her feet, or a baby may need medicine or a “C-PAP” (continuous positive airway pressure) machine delivering air.
Some babies have high blood pressure in their lungs, or “persistent pulmonary hypertension,” and be treated with nitric oxide administered through a tube in the windpipe.
Pneumonia is common. Your baby’s doctor may insert a tube into the lungs to take a sample of the lung fluid, identify an infection, and choose an effective antibiotic.
Your doctor may advise you to immunize your baby against respiratory syncytial virus, which affects virtually all children before the age of 2 but can be more serious in babies with heart or lung problems.
A baby may have a heart defect that can be corrected surgically or with medication.
Babies who are very small or sick may need to be fed through a tiny needle placed in a vein in the hand, foot, scalp, or belly button. Once they are stronger, they can receive breast milk or formula through a tube in the nose or mouth, a process called “gavage feeding.” Happily, babies this small generally don't gag. When the baby can suck and swallow effectively, gavage feedings will be stopped, and the baby will be able to breast or bottle-feed.
A baby born to a mother with diabetes will be monitored for low blood sugar, which can be treated by early feeding.
Babies born weighing less than 3.5 pounds are more likely to suffer bleeding in the brain, usually in the first four days of life. Your doctor can diagnose a brain bleed with an ultrasound, and measure the severity from 1, the mildest, to 4. Most brain bleeds resolve themselves with no or few lasting problems.
A baby born with a yellowish tint in her skin or eyes has an immature or malfunctioning liver. In these circumstances, doctors monitor the level of “bilirubin,” a liver by-product that causes jaundice, or yellowing, and can treat a high level with special blue lights that help eliminate the extra bilirubin, or a blood transfusion.
Small or premature babies may not have enough fat to store heat. The incubator will help your baby warm. A tiny thermometer taped to your baby's stomach senses her temperature and adjusts the heat in the incubator
Remember that we live in times when the medical care for newborns is sophisticated. In 2012, the Centers for Disease Control and Prevention reports, one of every nine infants born in the United States arrived early— before 37 weeks of pregnancy — but the vast majority survive. For every 1,000 babies that are born, six die during their first year, about two because they arrived prematurely.
You can help prevent a premature birth by quitting smoking, and avoiding alcohol during pregnancy, the agency says. The signs of early labor are the same, contractions every 10 minutes or more often, leaking or bleeding, pelvic pressure, a backache, and cramps. If you had a previous preterm birth, you might ask your doctor about a progesterone medication (17-alpha hydroxyprogesterone caproate, or 17P), or Makena. Mothers who conceived through assisted reproductive technology are at slightly higher risk of a preterm birth, mostly because they may be carrying more than one child.
October 15, 2015
Janet O’Dell, RN