Hi! I’m Ashley. I’m a Birth Doula, Postpartum Doula, Breastfeeding Counselor, Childbirth Educator, and NICU survivor! I’ve been through a lot completing my family of 3 children! My first pregnancy resulted in a 26-weeker with intraventricular hemorrhage, ROP, PDA ligation, sepsis, extra doctor appointments, therapies, etc. My second pregnancy I was on bed rest the entire time and in the hospital for 2.5 months with a difficult recovery but healthy baby. We decided adoption was our best bet when we wanted a third (That wasn’t very easy either)! I know if you’re reading this, you’ve been through a lot too. Maybe you’re going through it right now. I remember that feeling you’re feeling like it was yesterday even though it was 12 years ago.
I learned so much in my birthing adventures. I decided I wanted to help other families bring babies into this world in the most comforting and supported way possible, so I became a doula. I wanted to share some tips I’ve picked up along the way for the postpartum period that are unique to parents of preemies.
You’re feeling a lot, and that’s ok!
There are so many emotions when having a baby, let alone a preemie baby! I remember feeling euphoric right after delivery. I had no pain meds and I now know that our bodies can produce endorphins during labor resulting in a euphoric state to protect us from labor pain. I felt like an idiot for feeling so happy. Nothing had gone the way I had planned, but I was smiling from ear to ear…for a short while. After that euphoric state, I was scared, angry, disappointed, ashamed, jealous, calloused, jaded, broken, and empty; but the second she would have a small victory, I was euphoric once again. Then there’d inevitably be a setback and all those negative emotions would come flooding back. I always equate it to a rollercoaster ride from hell because the ups and downs of life in the NICU are intense! Allow yourself to feel these things, tough as they may be. If you hold them in, you’ll be like me and have an emotional meltdown in the middle of the freeway and need to be escorted off by a police officer. If you need to cry, cry. If you need to scream, scream (preferably at home or in your car). All emotions are welcome, normal, and ok to feel.
You need help.
In American culture, we have taught new parents that they are supposed to have their babies and immediately become super moms with six pack abs and an Instagram-worthy house all by themselves. While this is a total lie for ALL new parents, it’s especially true for preemie parents. You may be obsessed with being at the hospital at every waking moment or you may retreat and not want to visit at all. Either way, you need to rely on other people to support YOU during this time. You may be far from the hospital, unable to drive, or dealing with any number of other obstacles. If you felt like you couldn’t rely on anyone before you gave birth, you’ll have to find someone now. Love for Lily is a great resource for finding help when you need it. You can also look for a family member, friend, support group, or postpartum doula. Lean on others right now. It doesn’t make you weak, it keeps you stronger for your baby. People are also eager to help in situations like this. It may help them feel useful in a helpless time. Be specific about what you need and give them a task so they know how to help you in a meaningful way.
If you have a partner, they’re hurting too.
Sometimes when we give birth to a preemie, we are focused on our own suffering and disappointment. We didn’t get to have the experience we desired, we feel as if our bodies are in some way broken, and the loss of control over our baby’s safety and health is devastating. It can be difficult to allow ourselves to see the pain and suffering of our partners. We may feel like they have it much easier than we do, but everyone’s pain is relevant to them and deserves to be validated. They need to grieve and mourn the loss of expectations too, and it CAN be a great way for you to bond during this difficult time. Lean on one another and grow in ways you wouldn’t have had the opportunity to otherwise.
Your milk will come in.
After delivery, your milk will come in. If you planned on breastfeeding, there are ways to give at least some milk to your baby. You may need to manage your goals depending on what happened during your delivery. Postpartum hemorrhage, C-Sections, and delayed pumping can have a significant effect on your production. Keep reminding yourself that every bit of breastmilk is a benefit to your baby and depending on what gestation your baby was born, it may be a while before any food is given by mouth. This gives you some time to potentially stockpile some milk for when baby is ready. Donor milk is also an option while baby is in the hospital.
If you had to say goodbye to your sweet baby, be prepared for when your milk will inevitably come in around day 3-5 postpartum. It can be a really hard time for parents who are facing a loss. Have some emotional support in place around those days. You can choose to eliminate your milk as quickly as possible, or some moms feel better donating their milk. Whatever you decide is ok. I recommend all preemie moms talk to a good IBCLC (International Board Certified Lactation Consultant) to either eliminate supply safely or create an appropriate pumping schedule to maintain and increase supply. The IBCLC you see in the hospital may not have the time required to teach you appropriately, so if possible, seek out a good IBCLC independently.
If you want to try breastfeeding, it is possible. Perhaps not exclusively, and it’s a lot of work, but it may be possible and a great benefit for you and your baby. Hospitals have appropriate pumps for moms of preemies that can be rented out. Your insurance may cover the cost. Store-bought pumps don’t have the necessary power to maintain a supply properly. Hand expression is also a great option/addition to pumping, especially if a hospital-grade pump is not available. Pumping in your baby’s room is a great way to bond with them and feel connected when there are so many things stacked against your bonding. Skin-to-skin contact is a great way to increase your supply and bond as well.
If you’re having too much trouble maintaining a supply and you’re heartbroken over the loss of opportunity to breastfeed, you can utilize an SNS (supplemental nursing system). It’s essentially a bag you fill with milk with a tube connected that attaches to your breast. Sort of like an NG tube that attaches to your breast instead of going through your baby’s nose. It can be a great emotional replacement for breastfeeding for you and baby. You can use an SNS at any point, even if you weren’t able to establish your supply at the beginning.
Your intuition is the best diagnostic tool.
When my daughter was in the NICU, one night she kept having apneic episodes and she hadn’t had any in quite a while. I brought it up to the nurse and she said, “Oh. It’s normal for preemies to have apnea.” The next morning, I came into her room and she was septic. I don’t say that to scare you, it’s unlikely that the same thing will happen to you, but my point is, you know your baby better than anyone else. If something is out of character for them, let the nurse know right away and don’t let them foo foo your concerns away. You are an advocate for yourself and your baby. While there’s no way for anyone to foresee the future, you can help them to be on guard if something isn’t right.
You Don’t have to be available 24/7.
You don’t have to have your phone on all the time while at the NICU if the influx of well-meaning texts and calls feels overwhelming. Your focus needs to be on you and your immediate family. That’s a lot right now, and that’s enough. You can let friends and family members know where to find any updates; whether you’ll post on social media, or have a text chain, etc. This could also be delegated to someone close to you. You can even have a scheduled update everyday so family and friends feel connected, but you feel in control. For me personally, I turned my phone off for about 3 months. Looking back, this was probably hard on people close to me, but I just couldn’t deal with anything else. I defended my sanity, and sometimes you just have to do what you can to get through it. When you’re not at the hospital, always be near your phone as they may call at any time (usually for something as simple as a need for more clothing or food).
You don’t have to be at the hospital 24/7 either.
I know that sounds and feels wrong but hear me out. Having a preemie is not the same as having a full-term baby. If you had a full-term baby, if someone offered to watch the baby for a couple hours so you could go on a date with your partner, or take a nap, or a walk, or whatever, it wouldn’t be a big deal. You’d probably be so grateful for the break. When you have a preemie, we feel like we have to be there every single second out of guilt.
I totally get the guilt. Trust me! But you know what? It’s truly not your fault. It wasn’t my fault that my body couldn’t hold in my baby by itself, and it isn’t yours either. If someone has a cold, do you blame them for their runny nose and cough? Do you yell at them when they blow their nose, “Why did you do this to yourself? You’re a bad person!” No! Of course not! The same can be said about preemie parents. Your body didn’t do what you expected. That’s it. It’s not the best situation, but it says nothing about you as a person or a parent. While spending time with your baby is extremely important, spending a little time away is important too. You also have some highly qualified babysitters in the NICU nurses! Your baby will be in great hands if you just need a break once in a while. Rest while you can before baby comes home.
A Pinterest-worthy nursery is great, but not necessary.
You may not have had time to get your nursery set up the way you had envisioned. That’s ok. The AAP recommends that all newborns sleep in a separate crib, bassinet, or pack n’ play in the same room as the parents for at least 6 months to help reduce the risk of SIDS. Also, if your baby was not swaddled at the hospital, don’t swaddle them at home. Preemies need to stay warm, but loose blankets are not recommended while baby is asleep. Crib bumpers, stuffed animals, and all the other cute stuff we typically see in nursery photos are also not advised. All you need is a safe, firm surface for baby to sleep, clean clothes, wipes, and diapers. Everything else can be put together and purchased along the way. Preemies are typically put on a strict schedule in the hospital, so their feeding and sleeping schedule will be predictable and you can plan your decorating around that. Most baby carriers, swings, and chairs are not recommended for babies under 8lbs. One exception for a carrier is the Boppy Comfyhug. It’s one of the only tested carriers approved for babies 5-20 lbs., specifically designed in collaboration with NICU nurses and Preemie parents.
You need to eat.
That one sounds obvious, but it can be tough to remember/want to eat and drink while in the NICU. You have to leave your baby’s side and scrub in AGAIN! But it’s paramount for you to remain in good health. A lack of nutrition and hydration can wreak havoc on your immune system. Sick you, no NICU! If you are breastfeeding/pumping, nourishing yourself is even more important! The milk you produce will take whatever it needs to be good nutrition for your baby. If you are not supplying your body with nutrients, they will be taken from the nutrient stores in your body, leaving you mal-nourished. It takes around 300-500 additional calories of nutritious food and at least 8 glasses of water to sustain breastfeeding/pumping. It can be tough to find nutritious food that’s quick and easy. You can look for healthy options near the hospital or enlist some help in meal-prepping healthy meals for you to bring with you. Remember, asking for help is a good thing! If you know yourself, and know that’s going to be a problem, delegate the task of feeding you to someone willing to help. That way it’s one less thing you need to worry about and you just eat and drink when they say (even if it’s just a little bit).
Your baby is not as fragile as you think, and neither are you.
I remember being in the hospital all that time during my second pregnancy with my son and thinking how strong my daughter is for enduring what she did. She went through all I went through and more, and she handled it better than I did. Remember that when you get to start changing diapers, bathing, and feeding your baby. Be confident in knowing that you are their parent and you are capable of caring for them in the ways they need. You won’t hurt them, and you will be trained in any and all devices you may need at home. Allow your intuition to take over as soon as possible.
I remember my daughter would aspirate her food all the time. The first time I saw it happen, I panicked and didn’t know what to do and I yelled for the nurse. I felt afraid to be alone with my baby, but after I watched the nurse clear her nose and throat, I made sure to practice while she was in the hospital and not let the nurse do it. I learned to recognize the sound, so that when I heard it in the car or the monitor once she was home, I’d jump up and take care of it like second nature. The extra care your baby may need may seem scary at first, but practice under the competent supervision of the NICU nurses and you will be a pro in no time. You are the parent chosen for your baby and you can handle their care (remember that doesn’t mean by yourself).
You may become a germophobe.
Having a preemie may make you VERY aware of germs. The incessant scrubbing and talk of sepsis is enough to make you want to keep your baby in a bubble, but once baby is strong enough, they were made to be a little dirty. Think about it. They put EVERYTHING in their mouths and they’re healthier for it! It’s ok to be a sanitizer psycho in the beginning, but once/if baby is not immunocompromised, it’s important to let that fear go. Not only for the health of your baby, but for you as well.
If you panic when your baby is exposed to germs, you’re going to be in a perpetual state of panic. If you are having trouble controlling your anxiety, you may be suffering from a Postpartum Mood Disorder (PPMD). Symptoms of PPMD may look like bathing yourself or your baby multiple times a day, fear of visitors or leaving the house, constantly cleaning your home to the point of exhaustion, etc. If you or your partner are suffering from symptoms like these, it’s important to seek the help of a mental health professional. COVID doesn’t make a fear of germs any easier. Be careful and follow all safety guidelines, but while you’re home and/or away from others, it’s ok to kiss and cuddle your baby! In fact, it’s highly encouraged! Babies need lots of hugs and cuddles to thrive and grow, so enjoy your baby!
Other people will simply not understand.
There are all kinds of people in the world, and that’s a beautiful thing! Some people will rush to your aid and offer condolences and any help you could possibly need, and others may not know what to say or do and distance themselves from you. How someone reacts may surprise you. During my first pregnancy, I was pregnant with my very best friend at the same time. It was so much fun! She had her son just before I had my daughter (although we were supposed to be months apart). After my daughter was born, she didn’t quite know how to respond and our relationship was never the same. Although I’m sad about the way we drifted apart, it was just another thing I had no control over and I didn’t have the emotional energy to repair our relationship.
You may have someone in your life who wants to help so badly that they push you too far. They may not understand how heavy the emotional weight of having a preemie really is. After my daughter was born, my family very sweetly decided to throw me a baby shower since I wasn’t able to have one. I don’t even really remember it. The only thing I remember is yelling at them because they were trying to take pictures and I wanted to get to the hospital before shift change. It’s so NOT in my nature to yell at anyone, let alone someone doing something kind for me. In hindsight, I wish I would’ve just enjoyed my shower, but anxiety is real and demands attention in one way or another. Learn from my mistakes and find a positive outlet for your anxiety. Whether that be yoga, walking, talking with a therapist or support group, Find a positive outlet for your stress.
You may continue to get pity, guilt, advice that doesn’t apply to you, etc. Come up with some canned responses that make you feel in control of the conversation. If your baby is small and you go somewhere, people may give you dirty looks or make comments about taking a “newborn” out so early even if your baby is 6 months old. Or if they have oxygen or any other visible medical device, they may feel the need to ask questions or make comments. In the beginning it’s no big deal, but after a while, it may start to get under your skin. A reminder that your birth was “different.” Having a response you feel comfortable with, ready to go, can give you a sense of power back.
Ask lots and lots of questions!
Chances are, you didn’t research anything about preemies. Preemie babies are often a surprise announcement. There’s no shame in not knowing what in the world is going on. Nurses and doctors are required by law to explain procedures and answer ALL your questions unless the situation is an emergency. It’s called Informed Consent. While it’s important to do your own research on procedures as well, your nurses and doctors are there to explain everything to you. When making decisions about your baby’s care, a great acronym to remember is B.R.A.I.N.:
- B: Benefits. What are the benefits of the procedure and why does my baby need it?
- R: Risk. Tell me all the risks of the procedure and the likelihood of them occurring.
- A: Alternatives. Are there any alternatives to this procedure? What are they?
- I: Intuition. What is my intuition telling me about this procedure?
- N: Nothing. What will happen if we do nothing?
All the doctors and nurses are there for you, not the other way around. Ask until you are comfortable with your decision.
Having a preemie is such a difficult experience for families big and small. Please remember that this season will pass. Remain hopeful, for as long as there is hope, there’s a chance. Love yourselves, care for yourselves, and allow the outcomes of your experiences to bring you closer together. You are stronger than you thought, more capable than you feel, and more knowledgeable than you know. You’re going to be ok.