Showing posts with label support. Show all posts
Showing posts with label support. Show all posts

Monday, October 6, 2014

Post-NICU rollercoaster - A How-To

Hand to Hold just published a piece on surviving the post-NICU rollercoaster.

I wrote it. So if you want to see what advice I'd give on surviving all the medical complexities that can come AFTER the NICU, read here

P.S. If I haven't said it before --  I think "NICU rollercoaster" is a terrible term. Read the post to see why, and to see my alternative analogy.

I've started a one-woman campaign to get the nurses to stop saying "It's just all a part of the roller-coaster ride" and get them to be a bit more honest. "Yep, it feels like you're being jerked around. Because you are. It's hard. Just think of it like you're a giant yo-yo. See, isn't that fun? Oh, it's just disorienting and kind of mean? Yeah. That's the NICU."  A bit of honesty. The campaign's not working, but I have had small victories. Like two years ago when I got the nurses to stop using the roller-coaster analogy on me for a good two weeks. I think a wise NICU nurse wrote it in my charts. "NO roller-coaster analogies! TRUST me!"  Ranting here is just frosting on that cake.

Thursday, August 8, 2013

Day 22 - NICU Support

About two or three weeks after Jonathan's birth, I was talking to Cindy about support in the neonatal intensive care unit (NICU). You'll remember she had had a micro-preemie born just a few days after Jonathan. We hadn't met before our babies were born, but our husbands had become friends, or at least acquaintances, in the family room of the high risk pregnancy floor while she and I were stuck in our respective rooms hoping to stay pregnant a day or a week or a month or three longer.

When we did finally meet, it was at a "Lunch with Lactation" meeting at the NICU. Both of us were still sore from our c-sections and couldn't stand for long or walk too far.

I have to admit, the name of the meeting was unfortunate and confusing.  "Lunch with Lactation." Thankfully within a month or so they'd changed it to "Lunch with Lactation Consultants" or something of the sort and the purpose of the meeting became a lot clearer.

The meetings happened about once every other week, and we NICU moms (dad never attended for some reason) got free sandwiches and salads and huge chocolate chip cookies from Panera Bread and an opportunity to ask questions to the lactation consultants.

Since nearly all of us were pumping with a dream of someday nursing, it was hugely helpful.

Except that that first session it wasn't so much.

The first thing we did was go around the table and introduced ourselves. Sometimes birth stories came with the introductions (how often does that happen with complete strangers?) and at the very least we learned a bit more about the other infants in the intensive care unit. 

I felt a little alone, as we went around the table. I was one of the first to introduce myself, and I didn't get a lot of nods or knowing looks. There weren't too many micro preemie moms there. Each time someone mentioned a baby that was born before 28 weeks or under 2.5 pounds, I tried hard to remember who they were. It was increasingly hard to remember anything these days, so I made a point of trying to put those faces in my brain, so I could ask how things were going the next time I saw them on the elevator or in the family room. Maybe I should have made a point of remembering everyone, but I didn't have the brain cells for that.

J was the earliest birth. Only two or three others had introduced themselves as parents of babies born younger than 28 week.  As parents introduced themselves, I realized that weight at birth did not equal health at birth. One mom of a full term baby was in the room, and I think, being the only parent of a 8 pound or larger baby, she felt just as out of place as I did with my one pound baby. Her baby, her daughter, too, was struggling for life and trying hard to beat the odds. Before she was born her mother had already had to fight with doctors and transfer hospitals just to get someone to agree to give her daughter a chance, despite the odds, despite the potentially inevitable disability. It was humbling.

Cindy was one of the last ones to introduce herself. As she did, I though, "OH, THAT'S the Cindy I've heard so much about. I wondered if she'd be here. I was hoping she would. I wonder if she'll be my friend? I've assumed so, but she's sort of pretty and looks so well-put-together, and I'm a mess."  I realized it was awfully presumptuous to have assumed she'd be my friend, just because we shared the same floor of the hospital for a month. And then came the problem: How do I introduce myself to someone whom I've heard so much about, without seeming strange or awkward or overly enthused?

But she cut through all that with a look at me and a "I think our husbands have met. You're Jonathan's mom, right?"

Sure, she was put-together, but she was also warm.

The rest of the meeting was above both our heads.  The floor was left open for the moms to ask any question they had. Most of the questions were about nipple shields or HMF (human milk fortifier) and prolacta. These last two were things added to breast milk to up the nutritional content and calories for preemies. I had only barely heard of prolacta, and had no clue what HMF was. I was concerned about the 2 mls my son was getting. And how to keep up pumping.  I wasn't concerned about my supply, I made too much. I wanted to know how much I should be making so that when he DID reach a full-term weight, I'd still be making enough?  How long did I have to wake up every three hours every night to establish a milk supply? When could I start sleeping through the night?

But the women there were wondering about how to get HMF when they were discharged, and whether or not to try to leave the hospital entirely breast feeding their child or if they should try to get out of there bottle feeding (the easier way for preemies to eat) and hope that the breast feeding established itself when they got home. And how to tell how much their preemies had gotten. And if they should have scales at home. And how to get enough HMF into their child's diet if they were breast feeding exclusively -- was it even necessary? And when could they stop using a nipple shield (what the heck was a nipple shield?) and how to up their supply to make up for their baby's increasing demands and needs.

BREAST FEEDING?  That was so far away. It was a dream. I just hoped he'd make it that far. Under supply?  My son took only 1/16th of what I made in a day. He got it through a tube into his stomach.

The rapid fire of questions that were so above anything my son was dealing with left me overwhelmed and isolated.  I mean, they were interesting questions. To be fair, I'm sure if I were in a better and more optimistic state, I'd be storing them away for another day. If I hadn't just had a traumatic birth and wasn't recovering from three (yes, it was up to three now) forms of infection, maybe I'd have had more energy for this.

But moms who just had to teach their preemies how to eat and then they could bring them home?  They were in a different spot than me. I didn't know how to relate. I couldn't even pretend to be in their league. I wished I could, but at this point, I couldn't eve know if I'd ever get there.

Afterward, I met Cindy properly in the hallway. She'd felt the same as I had, which was a bit encouraging in a strange way. She asked if I'd gotten a NICU family support partner yet. I told her I'd heard of the program. It was this neat program in our hospital where other families of NICU graduates support current families of NICU babies and walk along side them, answering questions and being a resource and friend.

I told her I wasn't sure if I should.  "My son was born at 23 weeks. I think I'd feel even more isolated if I was partnered with a family that had a 26 or 28 week baby and thought that was the same thing," had been my gut response. 

"We've already met with our family," she said, "and they are amazing. The mom is so organized. They had this photo album of their daughter where they have a picture for every day of her life while she was in the NICU. Their daughter was born at 23 weeks, two years ago. She's adorable now. It sounds like they're really involved in their church, too. And they were really good about answering our questions. They told us how it was God's grace that had gotten them this far. And we were able to ask questions about what this meant for their faith,."

Suddenly I was interested. There was a family in the program, a family walking beside kids like ours, a family who had had a surviving baby, two years ago, born at 23 weeks.  I really wanted Cindy's support family to be OUR support family. I had a bit of support-family-jealousy.

That afternoon I signed up for the program. Even if I couldn't have Cindy's family, maybe there was another family like that out there.

A week later I got partnered with a family.  They dropped by Jonathan's area of the hospital to see if we were there.  We weren't. So they left a basket full of goodies -- Cookies that were cut into footprints, a sign that said "STOP, wash your hands before touching mine" and a framed image of Jonathan's name down the side, a poem where each letter in his name was the beginning of a promise.

A note inside said that they were excited to meet us, and that the signs would be useful when we took Jonathan out and about after he graduated from the NICU.

They thought he'd graduate from the NICU.  I looked at the signs, and the framed image of his name, and could only hope. Maybe he would.

I was exhausted. Steve was exhausted. Steve looked at me like I was crazy for signing up to meet a family like this. "Why are we meeting them, again?" he asked me, as we walked into the NICU at an appointed time.

"Because I need it." I said. I needed to know I wasn't alone. I hoped that this family had also had a baby as small, as fragile as mine, and that they could show me the way forward through this thick forest.  There had to be a path. Someone must have walked this road - or a road similar to it - before.

We met them in a private meeting room at the NICU. They brought a photo album. They'd taken their daughter's picture every day of her NICU stay. As I turned the photo album pages, I saw a baby that looked a lot like mine - all skinny with stretched skin -- slowly transform into a round cheeked baby and then the tubes began to be removed, and pretty soon only one thin tube, a nasal cannula, was all that remained on her face. And she looked like a baby. A happy, smiley baby.  And they had taken her home. And she had stayed their baby, their child, for years. Two of them, to be exact. And she had started out as a 23 weeker, too.  It was the same family that had adopted Cindy and her family. They were taking on two families at the same time. I smiled.

As Jonathan was still safe in his plastic bubble, I asked them if they'd like to come meet Jonathan. Tabitha, the mom, said yes. Richard, the father, however, had just come from work, and suggested that he should stay behind with Steve because, even though he didn't have any symptoms, he was feeling a bit under the weather.

Tabatha removed all her jewelry scrubbed her hands at the wash basin, up to her elbows for a full minute, and then walked with me to his room. She squirted hand sanitizer on before walking in, and never once asked to touch him.  Here was a family that understood our concerns about germs!

A few weeks later, I saw their two year old in the waiting room at the NICU. She'd come with her mom as it was her second birthday. She stayed in the front lobby and her old favorite nurses came out to say hello. I said hello to her too. She wasn't amused by me. She gave me a stern look like "whatcha lookin' at lady?  I don't know you, and there's nothing to see here."

I walked away smiling.

Miracles could happen. Thanks to doctors, advances in technology, and God's grace, babies that were all stretched skin and toothpick bones could become stern two-year-olds, scolding strangers with their eyes because, after all, as her eyes said, I don't know you. There's no reason to be looking at me.

You're just a miracle, that's all.

Maybe we weren't so alone after all.  Maybe there was a path through this forest. Maybe it ended in a glade where sun streamed in and grains and wildflowers danced in front of us, where there was a path, a solid stone path to walk on, and a horizon to see. Maybe we someday would be able to see into the distance and dare to dream about tomorrow. For the moment there was only thick undergrowth and a path so dense it felt like every step forward was half a step backward. There was no dreaming, because the next day might bring an abyss.

But maybe it wouldn't always be like this.

Maybe there was hope. Yes, there was hope. A stern and stubborn two year old told me so with dagger eyes. There was hope.

["Tabitha" - I don't know if you are reading this, but THANK YOU. Thank you so much for giving parents like me a bit of hope.  "Cindy" - I know you're reading this. Even though our paths were different -- yours mostly a long steep hill that never seemed to end, and ours full of thorns and pricks and stones to trip on -- even though they were so different, I am so glad that we walked these roads at the same time. Thanks, both of you, for helping us know we were not alone. Thank you so much.]

Sunday, July 21, 2013

What to buy for a micro-preemie?

A year ago today I had a handful of friends drop by the hospital to say "hi" and "congratulations."  For a few of this handful, Steve, the proud papa, brought them to the NICU to show them Jonathan through his isolette.  That shocked people who, like us, worried that they might break him. They all declared their health (no sniffles allowed!) and scrubbed in extensively before walking in the room, and even then they weren't allowed to open the isolette or touch him (or anything that touched him) so I felt fairly confident about it.

It was a little odd feeling. Part of the reason I wanted close friends and family to see him was that I wanted them to know him. I didn't know how much time we'd have with him. For the moment I felt like the isolette shielded him some.

I wanted others to see how perfect his fingernails were, how he already had dark brown hair growing in and the same widow's peak I had. I wanted them to marvel at how one so small could be so beautifully and completely formed. I wanted him to be known.

At the same time, I wanted him protected. And protected here meant low lights. No lights. Keep his eyes safe. Keep a blanket over the isolette. Looks were peeks and not long stares. Conversations about him happened on the way to the room or after we'd left the room, but we tried to keep his room quiet.

When he got moved into a crib months later I would become much more protective about even who visited. Knowing someone might carry a cold and not know it, might cough and have him breath it in, these things became risks. It might have been an illusion, but it seemed that the isolette protected him from us, from us. It seemed all right to bring one or two people by. If nurses and doctors could see him, I wanted close friends to see him too.

What do you get for a person who just had a baby, when the baby is very very sick?


A week after our son was born, another friend had a baby born severely prematurely. Like our son, their child was also on the brink of life and death simultaneously. We mourned that the pregnancy had come to an end, we didn't want them to join us in the NICU.  Not for months, if they could help it.

At the same time, they had a new baby.  We'd walked the bed rest road with them, from separate hospital beds.  We wanted to get something to celebrate the birth.  Even if this wasn't ideal, this was the baby's birthday. We must celebrate.

But what if their child didn't make it?

We understood better why we weren't getting showered with gifts and balloons, why reactions from friends were awkward and sometimes strained.

It's hard to know what to do.

In fact, it's hard to know if doing something, anything, might come at a very inopportune moment, if it might not hurt more than help. What if I buy this cute outfit, send it to them hoping their child will grow into it, and then... and then something happens?

To back up a bit, we saw the other baby's dad a few days before his child was born, a few days after Jonathan was born. Possibly even a year ago today, if my sense of timing is right.

 "Is he still alive?" was his first question to us as we passed him near the hospital food court, me in my wheelchair on my way back to the recovery room from the NICU, and Steve pushing from behind. From anyone else, to anyone else, it might seem rude, insensitive to ask. But from him, I saw in his eyes, it was the plea from a praying father.  He was asking if Jonathan was okay, he wanted our son to be okay, but just as much he was asking, "Can my child make it?  If my child is born today, what might happen?  Is there hope?  Can babies like this live?"

"Yes!  He's doing great!" we replied. And since he, like us, hadn't had a chance for a NICU tour, Steve made arrangements to show him the NICU -- just in case his child was born early too.

And the baby was. And now we were, a week out from our own delivery, trying to figure out how to celebrate life in a way that wasn't over the top, but still acknowledge and rejoiced in this new being. Because acknowledging is important. Remembering that we are new parents, that a baby has been given to us -- it is so important. We remember these early days.

So, finally, to my list.  If you have anything to add, or other suggestions, post them in the comments below.


THE LIST of micro-preemie baby birth present ideas

BUY

  • A card. Have it celebrate. Tell us you're praying if you are a praying sort of person, but also tell us that you are delighted for the new life. Because a part of us is also mourning the loss of all the baby celebration stuff. So, celebrating with us is important. But being sensitive to our possible sorrow (though not all of us experience that) is also important.
  • Gift cards to food places. Gift cards to restaurants or fast food places near the NICU is just as important as bringing us food. Unlike the moms and dads who take the baby home with them, our baby was stuck in a hospital. So we spent as much time as possible there, which meant we didn't have any time to put a casserole in the oven on some days.
  • Food and snacks.  Food is always good, even if it is a casserole that needs to be put in the oven, because it spells "comfort" and "love" -- and NICU parents need both.  If you can give us something that we can easily throw in a Tupperware and bring to then NICU with us, all the better.
  • Blankets/quilts. Especially hand made thick (crocheted or knitted) blankets and quilts.  We can use them to cover the isolette to keep the light out when the baby is still so small, and can use them as a blanket for the floor for "tummy time" when the baby is bigger.
  • Very tiny booties and hats.  If you're crafty, you'll have to make these. Or maybe there's a place online to buy preemie booties. My son couldn't wear them until he was three weeks to a month old, so if it's a very early micro-preemie, but the first "clothes" that these kids wear are hats and shoes.  Just make the booties out of stretchy fabric and/or so that they have a tie at the top so they can both go over the pulse ox monitor and still stay on. And if they're too big (they probably will be) baby will hopefully grow into them in the next few months.  Plus, this is a small gift -- a memento of how much the baby is loved.  Note that keeping heat in isn't a function of these earliest hats, so make them soft, comfy, and stretchy as well.  If the baby is on CPAP, they can't wear a hat probably.  So then just go for the booties.  And don't make them of cottony stuff that will get miserable in humid temperatures, because the baby's isolette will perhaps, for the first week, be very moist.
  • Flowers, but be careful. I love flowers.  I appreciated the ones that were cheery and bright. I appreciated the potted ones that I could add to my garden.  I did not like the huge bouquets that seemed appropriate for sympathy or funerals.  I also wasn't sure quite what to do with the ones that looked all baby appropriate. I couldn't put them in Jonathan's room, and at my house -- empty still of all baby gear, his room still set up to be my "bed rest room" -- they just looked silly.
  • A care basket for mom and dad. Something that says "recover well," because recovery from birth -- especially traumatic birth -- is hard.  Put in it food and snacks, cute cards they can write in, fancy sodas, cookies, (I like food, can you tell?) maybe a conversion chart from grams to pounds and ounces (those are really helpful), possibly even a pretty sign that says "welcome baby" to go on his or her hospital room wall.  They won't see it, but mom and dad will.
  • Our NICU had magnetic bulletin boards for every baby.  If your friend's NICU has the same, buy cute magnets to go on the board.  Bonus here is that (a) has a purpose in decorating the baby's room and (b) isn't huge, so if baby doesn't make it, mom and dad can either keep or toss (depending on how they deal with grief) without feeling too bad about it. 


DON'T BUY (at first)

  • Stuffed animals.  Most NICUs won't let us put these in the baby's room, so we will have the stuffed animals at home.  Plus, stuffed animals are preemie baby sized -- lots of opportunities for triggers here.  
  • Balloons -- although I have to say, when Jonathan came home, my neighbor tied a balloon to our mailbox that said "It's a BOY!!!" and I nearly cried.  Perfect. But these baloons are not allowed in the NICU, so again, without the baby at home, we just have a floaty celebratory item screaming a reminder that our child isn't there to celebrate his arrival with us.
  • Clothes -- well, not yet at least.  It was over a month before my baby was able to wear clothes, and then the hospital provided cute preemie shirts.  We DO want clothes (please!) but you can wait until the baby is near 27 to 30 weeks gestation to buy anything. If you get anything for a baby under 32 weeks, you may want to knit/sew it yourself. You may find even the preemie outfits to be too small.
  • Large items.  Again, we want them, eventually -- so if you really wanted to buy our baby his/her crib, do. But wait a bit. Or send us a gift card. My mother-in-law was born early, and her mother says that there was nothing worse than coming home every night for three weeks and staring at the empty crib at the foot of her bed, knowing her baby was far away.  Speaking of which -- showers.  If we're first time parents and then we have our baby three to four months early, we probably do eventually want but might not yet be ready for a shower. Not at first. Tell us you want to throw one, but understand if at first the idea of leaving our baby alone for a night to accept gifts for our baby -- it might be too much.  Give us a few months.
All of these are my opinions only, your friends might be different -- so ask. Here's another blog to give you some other idea. And this is designed based on my experience as a parent of a micro-preemie.  Premature babies born later in the pregnancy have different needs, so while the no balloons or stuffed animals stuff probably still applies, the other things may not.  And if you are reading this with a friend in mind, thank you for caring!