After our baby girl was born via emergency C-Section, she was still in a lot of trouble. She had swallowed a large quantity of meconium (poo-stained amniotic fluid) and blood (from the placenta separating prematurely) and so her lungs were full of fluid. She had also suffered protracted oxygen depletion during labor and delivery and was born blue and not breathing. The pediatrician got her breathing again and several hours later she was airlifted by helicopter from our local Island hospital to Massachusetts General Hospital (MGH) in Boston. There her NICU journey began.
We were in the Neonatal Intensive Care Unit for 5 weeks and during that difficult scary time I learned a lot of things that I had never imagined needing to know. It felt at times like I was receiving a speed-course in Neonatal medicine. Here are some of the most practical highlights of that education.
PUMPING BREASTMILK
When my baby was born she wasn’t able to breastfeed at all for the first two weeks and wasn’t able to take an entire feeding by mouth until she was six weeks old so I had to pump milk. Luckily all of the people around me were adamant that I should pump and they helped me to get a machine and to learn how to use it right away. I had always planned to breastfeed and I wanted to feed my baby my own milk under any circumstances, but without the support of friends, lactation consultants and nurses helping me to get started I don’t know if I would have succeeded at all let alone as spectacularly as I did. The physical pain following my emergency c-section and the emotional turmoil that I felt after my baby was whisked away from me by helicopter in the middle of the night made it nearly impossible for me to make decisions or get out of bed.
The morning after my baby was born my doula and a nurse helped me with the herculean effort of getting out of bed and into a nearby chair and they taught me how to use a breast pump. I had never anticipated needing to use a breast pump and I felt like a cow as I held the cups over my breasts and felt the suction of the machine start up. However as I watched the first golden honey-colored colostrum slowly pooling in the tube I realized that this was the only element of my birth/early mothering experience I was going to be able to have any certainty about or any control over. Pumping milk quickly became a lifeline of rhythm and routine in those early chaotic days. Every 3 hours I sat down and pumped milk. During the night when I was dozing in fitful pain I woke up every 3 hours to pump. During the day when my husband and I were sitting in our babies room watching her struggle to breath with dozens of tubes and cords and wires coming off of her tiny body, surrounded by nurses and a tangle of machines all beeping, hissing, pumping, ticking and alarming, I kept pumping every 3 hours. At first the only thing I could give to my daughter was my milk. I couldn’t hold her, I couldn’t nurse her, I couldn’t change her diaper, but I could give her my milk, so I pumped. Slowly my milk came in and each day I used a Q-tip to dab my colostrum into the corners of her mouth, trying to build up her gut microflora despite the antibiotics and sedatives and pain meds that were flooding her body. Slowly she was able to be fed more milk and less intravenous nutrients and slowly the supply of my frozen milk in the NICU freezer increased.
I never anticipated that my breastfeeding experience would begin with 6 weeks of using a machine extractor, but I’m so grateful that I was able to stick with the pumping and keep my supply going so that she could have her own mothers healing milk while she was recovering and so that my body was ready for her when she was eventually able to learn to breastfeed.
Coconut Oil and Cradle Cap
Many babies experience skin complaints in their first months, and one of the most common ones is Cradle Cap, it’s basically dandruff for babies. This flakey crusty skin can cover their heads and get into their eyebrows as well. The best solution I found was Coconut oil. Simply scoop out a spoonful, warm it between your palms and then gently rub it into the effected area, working it down into the roots of the hair and really greasing up the area. then using a fine toothed baby comb gently scrape and pick out the area, lifting the flakes away with the comb. You can only comb-scrape for a short time before the babies scalp begins to look pink and irritated so just leave the oil on the skin and come back again in a few hours to do a bit more combing and picking. The oil softens and loosens the flakes and seems to hydrate and heal the skin.
Coconut Oil was also really useful on other problem skin areas, like diaper rash, peeling hands and that weird face acne that babies sometimes get. An important note here: BABIES UNDER A YEAR OLD NEVER NEED TO BE WASHED WITH SOAP!!!!
WHAT WORKED FOR ME:
Coconut oil softens, moisturizes and heals all kinds of infant skin ailments most notably cradle cap. Skip the baby soaps and dermatologically tested products and just use straight up coconut oil.
DIARREAH & DIAPERS
My husband and I were kind of the dirty-hippy parents in the NICU, we were completely out of our depth surrounded by so much modern medical technology. The incessant beeping of a room full of machines that were keeping our child alive was as far as it could possibly be from the way I had imagined my first days as a new mother. I tried to compensate for our babies drugged up, medical introduction to the world by introducing as many healthy, nurturing things as I could. One of those “healthy” things was diapers. I asked if we could purchase our own diapers that were chlorine free and use those instead of the hospital issued pampers. The staff said yes of course we could so off we went to Whole Foods to buy our babies first pack of diapers. It was the only “normal” parenting thing we had any control over and we got her the dirtiest hippiest diapers we could find: Seventh generation diapers.
Here’s the issue. Our baby had to be on powerful pain medications like Fentanyl and Morphine which cause very liquid diarrhea poops. Our baby was also on a clock-based care routine so she only had a diaper change at her specified “care-times” every 3 hours. Seventh Generation diapers simply couldn’t absorb all that liquid and so as a result she was sitting in liquid poo filled diapers for over an hour at a time. Over the course of 3 days this resulted in her getting the worst diaper rash I’d ever seen. Raw, red and painful. We switched back to the Pampers and the rash immediately stopped worsening and slowly began to heal. Moral of the story? Sometimes hippie-derpy products just aren’t good enough.
WHAT WORKED FOR ME: Pampers isn’t a “natural” or “environmentally responsible” company but in an environment like the NICU where nothing is natural and a baby is being given all sorts of drugs with unpleasant and unnatural side effects like liquid diarrhea It’s simply more important in the short term for a product to be effective.
BOTTLE FEEDING
Our 5th and final week in the NICU was spent weaning the baby off of Morphine and trying to teach her how to get her milk orally, either through breastfeeding or bottle feeding. The hospital protocol required her to take in a certain number of ounces of milk every 3 hours and they insisted that she would tire herself out if she tried to eat for more than half an hour at a time. This set of rigid rules meant that we were always working against the clock, feeling stressed out and disappointed and she was never able to take a full feeding by mouth and always had to finish each meal by getting hooked up to the presser machine for a tube feeding (a thin orange tube went into her nostril and down her throat to her stomach.) I was adamant that she be allowed all the time she needed to learn to eat and not be put on a more long-term feeding tube (gastrostomy tube) so we were sent from MGH NICU over to a rehabilitation center called Spaulding in Charlestown. We spent a week there working just on bottle feeding (a more reliable way to measure how much milk she was getting than breastfeeding) and by the end of the week she was taking all of her milk by mouth and no-longer needed her feeding tube and after 6 weeks of hospitals we were finally allowed to go home! Here’s what worked for me and my baby:
Side-lying position: The occupational and physical therapists as well as all the nurses in the NICU showed me how to bottle feed in a modified upright cradle hold position where the baby was perched upright on my lap/knee facing me and the bottle was offered for her at a carefully maintained angle so that I controlled the flow. This never seemed to work for my baby. When I was left to my own devices up at Spaulding rehab I found out that she would take a bottle much more easily if I laid her down on a bed on her side and simply held the bottle at an angle so that she controlled the flow. See the picture above^
The other thing that helped was doing what they called “Ad-Lib” feeding. All that means is that we were allowed to take up to an hour to finish a bottle and if she paused for half an hour in the middle to burp, wiggle around, doze off, poop etc. that was fine and then she could continue feeding when she felt ready to. This made a HUGE difference. Suddenly she was able to control the experience and I just paid attention to her cues. If she seemed hungry I fed her, if she wasn’t interested in eating or got distracted that was fine too. It took away the stress of trying to accomplish the impossible feat of getting all the milk into her in half a stupid hour! We both relaxed, she learned how to eat in her own way and on her own time.
WHAT WORKED FOR ME: Experiment with different positions with the baby and the bottle, take your time, don’t push the baby or let stress overwhelm the atmosphere of the feeding session. Try to let the baby control the experience as much as you can.