These also have additional birth education.
The Birth Plan:
The following information is specifically for babies who survive a longer time after birth:
When Given Extra Time
- Provide breastmilk: Begin by pumping your milk, just shortly after the birth. Pump on a regular schedule even if you cannot give it to your baby right away (the hospital will help you store it), or even if milk doesn’t come in abundantly. For different reasons, you may have a difficult time initially getting your milk to come in. Providing breast milk for your child is the one thing you can do for your baby that no one else can. Your baby may feed with a nasogastric tube, and can receive your breastmilk that way. Your breastmilk may actually provide a sort of “sterilization” to this tubing, because of the sIgA and other proteins present. You might consider introducing a pacifier after each tubal feeding, to allow your baby to associate suckling with being fed. Latching on can be difficult for babies who haven’t yet developed the ability to suckle and breathe at the same time. Once baby latches on, he may eat often, but you will need to pump after feedings to empty the breast. You can begin feeding approximately every two-three hours after a good breastfeeding relationship has been established. Ask for help: utilize lactation support and contact the professionals around you for support.
These are tips to help breastfeed your baby, borrowed with permission from a mother whose experience is similar to yours:
- As soon as possible, hold your baby skin-to-skin, also called “kangaroo care”.
- Pump as soon as possible, and for 20 minute sessions, every 2 hours; do not reduce this to less than 8 pumping sessions in a 24 hour period.
- When pumping to increase supply, pump for a few minutes after the last drop.
- When pumping to increase supply, consider “cluster” or “power pumping”. Cluster pumping is pumping every half hour to hour for several hours. Power pumping is doing as absolutely minimal work but staying in bed and resting and pumping for 2-3 days.
- As soon as possible, let your baby nuzzle your breast.
- Don’t overstimulate with rocking while they are trying to nurse.
- Use the crossover hold.
- Weigh your baby before and after a feeding, without changing the diaper. The grams gained are almost exactly equal to CC’s of breastmilk.
- Invest in a scale and an SNS for home (and Tommee Tippee breastflow–not drop-ins) . Your NICU nurse may give you an SNS for free. You can use an SNS and a nipple shield at the same time if you need to. Put the tube on your nipple (a little past the nipple on top), and roll on the nipple shield like a condom, give the SNS a squeeze to fill the nipple of the SNS and then latch the baby on.
- Have your baby’s tongue checked for tongue-ties and pallet issues.
- Ask about cup feeding.
- Ask about going home with your baby still on the gavage (see the study from Cochrane for more information.)
2. Bond with his caregivers: Natalie, the mother of a 25 week baby, said, “Although you can’t do a lot with a 25 weeker, it’s nice to know how your baby is used to being handled by the nurses and doctors. This way, when you DO take over care, you can maintain consistency for your baby and help him/her to feel safe. In addition, knowing what was going on – in detail – helped me feel like I was getting to know (my daughter’s) personality even though I couldn’t interact with her the way normal mothers can. Like how much she liked to try to extubate herself, and how much she hated those wipe-down baths.”
3. Talk to your baby: If you feel silly talking to a baby, read a book. It doesn’t have to be a children’s book – any will do! If you can’t go to the hospital as often as you want, record your voice talking and singing to your baby. The staff can play it when you aren’t there.
4. Hold your baby: Hold your baby as much as possible, but know that the earlier a baby is born, the more likely they are to be unable to tolerate touch. Touch can be painful or upsetting to the baby, and they show this by dropping their heart rate and oxygen levels. It’s very hard, but those are your baby’s cues that, just for right now, he wants to be left alone. Just as you would respect a term baby’s cues to be left alone to sleep, you need to respect your preemie’s cues.
5. Decorate his room: Bring in pictures from home – your older children, your pets, the grandparents. Bring in special stuffed animals and colorful blankets to cover the incubator. Make this “new home” as homey as possible.
6. Leave your scent: You, your husband, and your older children can sleep with some soft cloth items and leave them for your baby. Large burp cloths and receiving blankets work especially well. You can pump with a burp cloth under your breasts so that any milk that drips can catch on the cloth, and then you can leave the cloth for him. Later, after he’s had it for awhile, you can hold it close to smell your baby as you pump; his scent can facilitate a milk “letdown.”
7. Dress your baby: As soon as the staff gives you permission, bring in his clothes. Don’t worry if they don’t fit perfectly.
8. Take pictures: Put together a little photo album to share with your friends. Your baby is a gift and should be celebrated!
9. Celebrate your baby: Find joy in his birth, and other “firsts”, like his first bath or the first time he comes off of the vent. Take pictures and enjoy his tiniest, newest milestones.
10. Pray: Let the miracle of your child’s life stay the priority while managing the conflicting and painful feelings of the experience. Get support, and keep an eye for signs of postpartum depression. Connect with other parents and with your church family and allow others to pray with you and share in the ways God is moving in the life of your family.