What is it like as a new mother in the NICU where you also work as a nurse? Keep reading to discover my journey as a new mama.
The moment you have your baby is one of the most joyful, relieving feelings in the world. After months of mood swings, food cravings, and constant peeing; you finally give birth to your baby and see the fruit of your labor in their amazing, little body. For the majority of labors, mother and baby are healthy and make it to term. For other mothers, it may be a surprise that their little one decides to make an early entrance and be pre-term. Now, when the baby is born, he or she has a possible stay at the neonatal intensive care unit (NICU).
For my hospital, any baby that is under 36 weeks will be evaluated in the NICU. I cannot speak for other hospital policies so it may vary depending on where you are. The providers for the NICU will come evaluate the baby if the labor and delivery nurses and doctors anticipate needing more assistance. The moment of happiness and joy and new life turns into confusion and sadness that you’ll have to weather on your own while your newborn fights for their life in another unit of the hospital.
It is a scary process in the beginning when you realize that you are now a NICU parent and have to jump through all the hoops to get your baby discharged from the hospital. What is wrong with your baby? What did you do wrong? Will my baby be okay? How long will the baby have to stay? What are those tubes and stickers all stuck to your baby? You are not alone in this process, mama. Here, I talk about my own experience and everything that I have learned as a NICU parent that I hope might help you through this process.
I work as a NICU nurse so I will try to describe and explain some of the harder medical terms throughout and list some things that may come up in someone’s NICU journey but may not apply to my personal NICU journey. Becoming a parent in the NICU is very different from when you are the one taking care of other parents. As I delve into my story, I try to share everything I learned as a parent and as a nurse in my own NICU journey with my daughter.
My story
My husband and I have a background in healthcare as newborn nurses but this experience of becoming parents was a first for us. We enjoyed going through this pregnancy, but we were also nervous on how we would go through the labor and delivery experience for the first time. We were very excited and as we inched closer and closer to the finish line, we grew just a little more anxious. We thought that we would be giving birth closer to 40 weeks and never anticipated what was about to happen.
A few months ago, it was just like any other night where my husband and I would cook dinner together and watch some television and snuggle before laying down for the night. I was expecting another full month of little kicks and movements from my baby in my belly, but I had gone into preterm labor and was in so much pain at 35 weeks and 3 days. I had no warning, everything had gone well in all of the prenatal care check ups and I had felt good.
The night I went into labor, I felt uncomfortable. Unlike the typical pains of the third trimester, I knew something wasn’t right. I felt cramping more than usual and I felt more nauseated that I had a hard time eating. I could not sit or stand for too long without feeling like a muscle fell asleep or cramped up; I was antsy and anxious.
I had more trouble going to bed than usual, but eventually I fell asleep. At about 2 AM, I woke up with sharp pain after I felt a strong kick and heard a popping sound and felt like I had peed myself a little. I knew it was time to go to the hospital when I was unable to relax during this pain and would hold my breath. It felt like I was going to pee and poop my pants and I had to hold my legs together to feel okay. I was in full labor and had the baby two hours after I had arrived at the hospital. Read more on my labor story here (later post, thanks for being patient). When I realized that I did not have a normal birth and my baby could not be beside me in my room like typical births, I felt devastated and distressed. It did help to know she was in good hands across the hall in the NICU where I work I as nurse. She needed breathing assistance and a good assessment for infection.
This was also my first baby so I was experiencing everything for the first time and Googling “how do I know if I’m in labor” and anxious about everything I was feeling. The prenatal care visits helped me get my questions answered and feel better and like I knew everything was going as expected.
That night, I was timing my contractions, and they were irregular but I wasn’t too worried about them. It was a pain that I could easily handle when I was able to move around and focus on relaxation. I did this for hours that day, checking my stopwatch on my phone and timing my contractions to see if I could find a pattern. I could not find any pattern and that made me think maybe this was my body preparing and just going through Braxton Hicks, which are practice contractions. These are your uterine muscles tightening up like a fist then relaxing in preparation to push the baby out. A couple hours passed and I ate dinner and went to bed like any other night of the week.
The NICU Transition
My daughter needed some assistance breathing shortly after she was born due to respiratory distress, so the NICU nurse practitioner present at my birth told me she was going to take her to her own bed space where she would have a dedicated NICU nurse help her transition into the world safely. At my hospital, the NICU is notified for any possible births under 36 weeks and a NICU nurse practitioner comes to examine the baby to evaluate whether they need any assistance to transition into the world. I had a few minutes with her on my belly doing some skin to skin time as they evaluated her and I felt so relieved she had arrived and I fell in love. Her care team took her soon after to help her breathe better with the proper resources in the NICU and I was in no condition to follow her to make sure she was okay so I delegated this to my husband.
My husband followed her as the care team got her admitted into the NICU. Our baby girl had lines and wires attached to her as the care team dried her off some more. From my perspective as a nurse, it is like organized chaos that happens when a new baby comes into the NICU, many nurses come to help get the baby connected to the monitor and get their weight and measurements, and get an IV. Additionally, the nurse practitioner and doctor will assess whether the baby needs medications such as antibiotics or perhaps they need more breathing support.
As a mother of a preemie, my girl got bubble CPAP for breathing support because she was not breathing on her own the best she could be. Bubble CPAP is a non-invasive ventilation mechanism where the baby can have some pressure or air in their respiratory systems so that their new lungs don’t completely collapse during an exhale and they don’t have to work hard to keep their lungs open. It may seem extremely scary but it is a great way to help the baby without doing more invasive procedures. When you see your new baby in NICU equipment, it is very easy to freak out and struggle being there watching your little one. There are so many unknowns, but likely the nurse and doctors are explaining what the plan is and how it helps your baby. Take a deep breath and take it step by step, day by day, hour by hour if needed. Your baby needs time to grow and heal.
It is absolutely okay to not know what is going on and to be scared to go through this difficult time. Always ask questions and ask for help if needed. Especially if your child is very sick, you will need support. When a baby does get very sick they may need escalated care which may mean the need for more invasive procedures such as being intubated with a machine to help them breathe for a little while. As the baby grows and gets better, their breathing support can be weaned off decreasing their extra oxygen need or extra flow need, they may even be on room air by the time they go home.
My baby girl also needed an IV for IV meds like ampicillin and gentamicin which are typical antibiotics to help with infection. She had ampicillin for one week, so she needed her IV for this whole week. As a mom, it is incredibly heartbreaking when you know she needs to be poked and restrained so that she can get these medications and it is hard to watch but you have to remember this is likely what is best if the nurse practitioner who has years of experience recommends this line of care. My girl had IV after IV, often pulling them out, but eventually she made it. After seven days, we were ready to go home. Some other fluid access you may see in the NICU are central lines such as umbilical lines or peripherally inserted central catheters (PICC) which are typically in the right arm. Luckily, my daughter did not need a central line; they can be tricky to put in and are a risk for infection because a central line is like a very long IV that goes deep into the vein towards the heart.
As the care team gets line access, they also get some blood for lab work to narrow down what is going on with the baby. Very commonly, you may hear CBC (complete blood count) or CRP (c-reactive protein) or BMP/CMP (basic or complete metabolic panels). These labs all depend on what the doctor or nurse practitioner thinks is relevant to the situation. For me, my daughter had her routine blood sugar checks and she had CBC and CRP and follow ups.
Sometimes, the baby will be under phototherapy, which is a special light to help drive down bilirubin levels. Bilirubin is the substance that is made when red blood cells eventually break down in the body. Preterm babies usually have immature livers and can have trouble getting rid of bilirubin so it accumulates in the bloodstream and has a yellow pigment to it which causes some jaundice to the baby. So my daughter needed phototherapy for a few days and it was hard to hold her because I knew she needed to be under the lights. I longed to hold her skin to skin more hoping she would feel better and that her body would heal like a newborn. The nurses placed my daughter in a small linen called dandleroo made to help them feel swaddled and contained but also helped their skin absorb the light to help drive down the bilirubin. She also got goggles to help protect her eyes from the bright light.
Eventually, as my daughter was breathing better on her own, she was able to be weaned to room air with no issues. Sometimes babies have “spells” which means they have a drop in heart rate or they desaturate or desat, which is when their oxygenation percent drops. I was lucky she was able to be back on room air. In the high elevation where I live, many newborns go home on a little bit of oxygen for a while.
Babies in the NICU commonly get a nasogastric tube or NG tube as they begin to feed, this is a small tube that goes into the nose and down the throat and rests in the stomach. Providers in my unit like to encourage breastfeeding as soon as possible and my daughter was showing signs of wanting to eat: aggressively sucking on the pacifier, turning her head looking for the nipple, sucking on her hands. However, she needed the NG tube the first couple days as she was still on breathing support.
Many babies are tube-fed in the early stages because they have too much going on in their respiratory support and that can make it difficult to eat. I have heard eating at this time is like eating while your head is out the window of a driving car so it is uncomfortable and difficult and there is the increased risk of aspiration. The care team also looks at readiness to eat when they decide to advance the baby’s diet plan. Two signs of readiness are alertness and pacifier use.
I was super elated when the providers gave us the go ahead to work on feeding my daughter. She had a formula called Neosure 22 calories/oz while my milk was still coming in as I was healing. Eventually, I was able to breastfeed my daughter and get a lactation consultant to help me, because preemies eat differently and it was also my first time breastfeeding, but more on that experience here.
Some parents are really adamant on breastfeeding and using breast milk, and the care team does their best to listen and respect their choice. Sometimes, they are able to get donor breast milk but sometimes they try to explain the options. My milk took a while to come in but when it started I was able to bring 1 to 5 milliliter syringes at a time and that’s what my baby got on top of the formula. I also did not go to the hospital for all of her care times. Care times are typically 3-4 hours around the clock, where the nurses assess the baby, feed them, and change their diaper. Being postpartum was exhausting and I had to balance out resting for myself, while pumping milk for the baby, and going to and from the hospital. Of course, my husband was very helpful for supporting me, driving us back and forth and making sure I took care of myself. However, providing breast milk for our baby was all on me. My goal was to get her out of the hospital as fast as I could so it would be easier to care for her at home, so I went with bottles and formula and whatever the care team thought might be best for my daughter.
One thing that my husband and I liked is that the whole care team gets together once a day typically in the morning to discuss all of the “cares” for the baby with the parents if they are present. This is a great way for everyone to be on the same page about what is going on and a great space to share and advocate for what you prefer in cares.
For my daughter, the care team seemed to be advancing her feeds too slowly, so we were able to ask about the possibility of advancing faster. With my NICU work background, I knew that this was a legitimate request and not out of reach; I mentioned that I noticed that my daughter finished her bottles quickly and seems to want more. I have seen parents be unsure what to look for, and that’s okay. Rely on your care team and ask questions–the worst that could happen is they say no and give you their reasoning so that you understand.
As we were getting close to the finish line, I knew she needed antibiotics for 7 days and that was my goal to get her out after that IV was not needed anymore. She was already eating ad lib, which is whatever amount she wants, and at least every 3-4 hours. She was peeing and pooping with no problem and gaining weight slowly. At this point, I knew that I needed to start the discharge process. So, of course, every hospital does this differently but this is my experience.
Typically, the NICU has a folder with a checklist for the family to complete by the time they go home. The list includes watching videos to learn CPR and demonstrating CPR to the bedside nurse and learning about shaken baby syndrome. My daughter also needed a carseat trial to make sure she could sit for a period of time without any spells. And lastly, we needed a hearing test.
Education for discharge begins on day 1 so families know what to expect while their little one is on the unit. For my husband and I, we knew our girl needed to stay at least through her course of antibiotics so we worked on our checklist with the hope of going home on the last day of antibiotics. The goal was to have nothing that would impede us and slow us down before discharge. And eventually, when day 7 rolled around, we were finally able to get our baby home.
It was a great advantage to be a nurse in this NICU and to personally know all the nurses taking care of my daughter. I even knew all of the protocols of the NICU. It is a very different perspective as a parent in the NICU, which feels like I don’t have complete control of the situation and environment as the caretakers do.
As a nurse, I feel like it is important to involve the parent and try to get them to work with their own baby as much as possible to try to help them bond as closely as possible in a strange environment. As a parent, I feel like I wanted to be at my daughter’s bedside 24/7 like how I was supposed to be originally if we had a normal birth experience. It was physically and mentally draining to come to the NICU to be with my daughter. It took all of my energy to focus on her in the NICU but it was worth it because I knew she needed her parents there and I knew I needed her to help me feel whole again. For me, I worked on breast pumping every 3 hours when I had to go home and rest and kept thinking about the goal of bringing my girl home as soon as possible. I took it day by day, sometimes even hour by hour. It takes a lot of patience to feel okay in this situation of being separated from your baby and to make the commitment of going back and forth especially while you are still healing from giving birth.
When the ultimate goal of bringing your own child home from the unexpected NICU stay finally happens, it feels like life is just about to be okay again.
Notes
There are so many other cares that are involved with premature babies in the NICU, and it all depends on the baby and situation. Some topics I did not even touch are eye exams, MRI, X-rays, echocardiograms, circumcisions, other procedures and more. Lots of the cares presented in the NICU can also be researched online or even better, asking the baby’s nurse. Getting education in your baby’s care is one of the best things to help you understand what is going on and how to get to the goal of getting your baby home. So for all my fellow NICU mothers out there, you are so strong for getting through this journey; it may not be your choice but you will get through it eventually and you will grow into a more knowledgeable mother.
Leave a comment: I would love to hear about your journeys in the hospital. What was your NICU stay like? How long were you there for with your baby?
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