NICU Tips from a NICU Mommy Veteran

People who know me know about my Princess's NICU journey, and if they find themselves in a similar situation I am asked for tips.  So I decided to make a list and share with anyone willing to read it ;).

My first time meeting Princess after I delivered her.

1. Take it day by day - there's too much that can happen in one day that can influence the next.  This mindset is the only way I kept my sanity during those five long weeks (which in the NICU realm isn't even that long).
2. Make your baby's room comfortable - because you will be spending a lot of time there most likely in that rocking chair.  I brought my Boppy pillow and a travel neck pillow for myself.  I would also bring a comfy blanket for yourself.  I often napped with Princess while doing skin-to-skin time, so these items ensured comfort for the both of us.
3. Pumping bra, nursing cover, and nursing shirts will be your wardrobe staples (if breastfeeding/pumping) - I would pack your pumping bra in your purse (if you don't have one, get one; it's God's gift to pumping mamas) and wear nursing shirts.  I would keep a nursing cover in the NICU.  I didn't think to do any of this until later on in Princess's stay, and I would have loved to have been more covered while visiting with her.
4. Take a million photos and videos - I can't emphasize this enough!! I treasure every moment captured on film.  I regret not taking more videos.  It's so neat to look back and hear baby's teeny sounds, watch their movements, and witness how quickly baby was growing and changing.  I never thought I would want it but I recently found a picture my husband took of Princess's giraffe bed.  You may never forget what that room was like but I can't wait to show Princess these mementos when she's older.  It's an important part of Princess's history and our family history. 
5. Keep a record/log/calendar of baby's stay- our NICU gave us a special NICU calendar with stickers and NICU-specific questions to fill in.  Everyday I would record Princess's weight and anything significant that happened that day (hearing screen, car seat test, etc.). I was also tracking her bilirubin levels when she struggled with that for a couple weeks.  At the time it helped me see progress, and I looked forward to using the sticker that said "Going Home".  Princess's nurses also seemed to like it as I had it hanging in her room. I'm so glad I took the time back then to do all that because I wouldn't remember half of those details now. 
6. Research - Most commonly used prenatal and newborn books don't have a section on the needs and care of preemies so do your research.  My NICU had a booklet on these things for each gestational week, which was an eye opener!  In Princess's first week of life no one told us of this resource there, and we were unknowingly overstimulating Princess every time we visited.  I felt awful once I realized it!  We had several visitors come in one day, we would flip on the lights, and we weren't watching our voice volume.  I cringe to think of how stressed my poor baby was during that time.  Preemies need dark, quiet, and as little stimulation as possible.  Preemies also need firm touch as opposed to the light strokes myself and other visitors were doing (seeing a baby that small I always worried I was going to hurt her).  Their nervous system just isn't developed enough to handle light touch and other stimulation.  We were told light touch to a preemie is like someone touching your fresh sunburn...ouch! There are also several web sites devoted to preemie care.
7. You are an active member of baby's treatment team - Just because you aren't on staff does not make you any less important in your baby's plan of care!  You don't necessarily have to be there for doctor rounds every day but I would recommend attending a few throughout baby's stay.  We had a fantastic team but every nurse we had had their own idea of what Princess needed to accomplish before discharge and when that would be.  After a couple weeks of getting my hopes up and then crushed I attended rounds to ask the doctor (who is ultimately the person writing your baby's discharge order) what was the discharge criteria. 
8. Ask for primary nurses for each shift - consistency in care is optimal so when you find a couple nurses you feel comfortable with ask for them to be baby's primary nurse for that shift.  It helped ease a little bit of my worry when I wasn't able to be by Princess's side to know she was in good, trusted hands.  Likewise, the nurses will get to know the quirks and likenesses of you and your baby which makes for (hopefully) seamless care.
9. Ask questions - if you don't understand something about baby's care, ask!  Not every parent has a medical background (and even if you do), there are no stupid questions.  You need to know what's going on with your precious bundle of joy.  This is especially pertinent when you are being told what you will need to do with baby once he/she is home.  If the nurse can't answer your question request someone who does to explain it you. 
10. Join a preemie support group - I didn't find this until after Princess was discharged but I'm part of a preemie mom Facebook group.  It is an amazing resource! The other mothers, who are from all over the globe, are very supportive of one another.  Also, many mothers have similar experiences and serve as a great expert panel when you have questions about your mysterious preemie. I wish I would have had to this when Princess was in the NICU. 
11. It's okay to grieve  - you are likely to grieve the loss of your planned birthing and hospital experience, or grieve the loss of the end of your pregnancy.  It's perfectly normal so don't feel ashamed! I'm still working on seeing other new moms' first picture of them with their baby right after they birthed him/her in the delivery room.  I birthed Princess, the doctor quickly held her up for me and she was immediately whisked into the NICU.  I didn't get to hold my baby until later that night (I birthed her at 1:09 p.m.).  Every preemie mom has a certain trigger or sore spot related to their experience.  Though it's okay to grieve, if you are concerned you may be suffering from post partum depression you should seek professional help (which there is also no shame in doing). 

Okay those are the biggest things I can come up with but if you have any you would like to add please leave a comment.  I would love to hear it!

Swaddle Transitioning

A month ago I had a physical therapist from Early Intervention come out and assess Princess to see if she was developmentally on-target for her adjusted age due to some concerns I had. During this appointment I asked when I should start transitioning Princess out of being swaddled. She was scooting around in her crib at night but she so loved being swaddled. The therapist said now was the time to transition her but that night was a nightmare for Princess and I that ended with a swaddled baby so we could get some sleep at 3 a.m.  After this defeat I turned to my fellow mommies in my preemie support group online. Many moms said they waited for their child to let them know when they didn't want to be swaddled anymore and Princess was still young (4 months, 1.5 adjusted). Other moms shared with me special transitioning products like Merlin's Magic Suit and the Zipadee Zip suit.  I, however, wasn't interested in buying special products and having to transition Princess out of those too.  So I waited for the time when Princess would "tell" me she's over being swaddled (and prayed it happened before her 10th birthday haha).

So fast forward to a month later.  She had been flopping around her crib like a fish out of water all swaddled up and her arms were making their way out a lot lately too.  After googling swaddle transition I found these were my cues Princess was ready to be swaddle-free. So one night I swaddled her one arm out (I left out her left arm which finds its way out of the swaddle most). She slept so well I decided that the next night I would swaddle the left arm and keep her right arm out. She again slept great. So the next night I kept both arms out and she slept unphased. I will say it is taking her longer to soothe herself to sleep being unswaddled but at least she's sleeping as she normally would, unlike a month ago when I tried it and she would only sleep in 30 min intervals.  I got the idea to transition her by pulling one arm out at a time from a mom in the support group. No fancy items needed, not to say they aren't helpful for others.

Goods to Take FROM the Hospital

I want to start this post by saying that everything you are given in the hospital is paid for by your insurance so it's not stealing.  Some of it will be charged to your account even if you don't use it because once something disposable is in your room, it's an infection control issue to let other patients use it.  This includes unused diapers and formula (a fact I wish I had known when Princess was admitted).

For Mommy:

• For the pumping/breastfeeding mommy - take all the breastfeeding supplies you are given.  I only pumped for two weeks but my lactation consultant gave me an extra set of supplies to keep in the NICU and special extra large flanges (I wouldn't consider myself busty but your nipples blow up when you are breastfeeding - fact).
• Bath basin - I took two, one to soak my pumping supplies and one to soak our bottles once Princess came home (see my post on washing bottles for more info on this).  They are perfectly sized for soaking these items.
• Perineal ice pack or what I call "vagina ice" - these feel great on your sore vagina! I didn't have any tears but I imagine they also feel great for mommies who suffer from tears.  I asked for more before I was discharged so I could continue icing at home.  I loved my vagina ice during recovery and HIGHLY RECOMMEND taking as much of it as you can before you are discharged.
• Pads - the hospital pads are ridiculously large but SUPER absorbent.  They will save your panties when you get home.
• Any other items used to help you recover

Perfect picture taken from another Mom's blog "Ten Things to Swipe from the Hospital"

For Baby:
     - I would have your partner, mother, friend, or whoever is helping you out stash this stuff each time they leave.

• Diapers
• Formula (if applicable)
• Bulb syringe - the hospital one is better than the one I bought at the store. If you are paranoid about choking like I am you will want one in every room of the house. The NICU had to change her syringe every week so I always just took it home instead of having them throw it out so I could accommodate my neurosis ;).
• Receiving blankets - these were recommended by my NICU to take home for swaddle baths.  I also used to bring home Princess's old hospital blankets for her puppy brother to get used to her smell before she came home.
• Any baby hygiene supplies - the NICU provided us a brush, comb, bath wash, and baby oil

Baby stuff is expensive so you should stock up on this "free" stuff while you can.  Happy saving mommies!

Hospital Bag for Bed Rest, Birthing, and NICU

Since Princess decided to arrive 10 weeks early I never technically packed a hospital bag.  But I will share with you what I would have packed and items I was really glad I had my husband get from the house.  I was on bed rest in the hospital for five days before Princess arrived, and then I stayed another two nights to recover from my vaginal birth.

While I was pregnant I was oddly always worried about the baby coming early (mother's intuition?) so I had posted a status on my Facebook asking what other mommies recommended for their hospital bag.  The best advice I got from that was SNACKS!

My List:

• Snacks - my hospital had pretty strict ordering hours so this was beyond needed for my infant-like eating style of needing to nibble on something every couple of hours.
• Cell phone and charger - this really doesn't require an explanation but whether you go into preterm labor or have a normal labor and delivery there are A LOT of people that will be trying to connect with you for updates and baby pictures.
• IPad/laptop - this was more for my husband because I mainly just used my phone.  However, there were times when I was on bed rest for the week that we would watch Netflix on his iPad together.
• Toiletries - you get the basics in the hospital but showering with my own body wash and shampoo made me feel like a million bucks when I was in the hospital. 
• Robe - I only ever wore a hospital gown so this made me presentable for guests.  It also kept me warm on my walks to the NICU.
• Comfy socks/slippers - I walked back and forth to the NICU in my slippers.  They also kept my feet clean and warm when I had to go to the bathroom all 550 times while I was on bed rest.
• Cards or card games - watching TV gets boring after a few days on bed rest so my husband and I started a pretty mean UNO tournament.
• Books/magazines - I had too much anxiety to focus on reading but it would help pass the time.

NICU Bag:

• Neck pillow - you will be spending A LOT of time in the rocking chair/recliner next to baby's isolette so be comfortable!
• Comfy socks or slippers - again it's all about comfort when you are lounging out in your baby's room for hours on end.
• Boppy or similar pillow - whether or not you breastfeed this pillow is great for when you get to snuggle baby or even for bottle feedings! We hold our NICU babies a lot and even though they are tiny, your arms will get tired.  Boppy is a great support for just holding or feeding.
• Hats and outfits for baby - it may be awhile before baby is allowed to wear clothes but generally they can wear hats most of the time.  Princess had quite a hat wardrobe going for a while when she couldn't wear clothes because of being on CPAP or dealing with jaundice for a couple weeks.  We were also given a few hats by the NICU thanks to volunteers who make them (I think this is pretty common in most hospitals).
• Transition toy or lovey - the NICU gave us Snoedle, which is a fabric doll volunteers make for the babies that the mom's sleep with and keep in baby's isolette so they smell mom.  All the other toys we already had for Princess were so much bigger than her when she was in the NICU so Snoedle (whom I call Snoogle) was Princess's transition toy.  I still keep it in her crib and sleep with it from time-to-time so it maintains my smell. 
• Childrens book - it's never too early to start to read to baby.  We kept Princess's children's Bible at the NICU and would read her stories out of it sometimes. FYI I'm not the most religious person but having my baby in the hospital definitely changed things. 

Things others recommended I wouldn't:

• Your pajamas - ladies after birth isn't pretty, and you are not going to want all those bodily fluids on your pajamas.  Hospital gowns aren't sexy but you don't have to launder them :). 
• Your panties - so I would recommend these if you are on bed rest but not after you've birthed. Again, gross bodily fluids don't need to ruin your panties when you're given the disposable hospital ones.  The one time I did wear my own panties after I birthed was because when I was wearing the perineal ice packs (aka vagina ice) they weighed down the disposable panties too much so I wore my panties on top of the disposable ones for more support.  If you insist on wearing your own panties just make sure you use your designated period panties so you won't ruin a nice pair.
• Pregnancy book - if you are in preterm labor throw it out, it's no longer useful.  What To Expect When You're Expecting only covers average/normal labor and delivery.  I felt like once I was admitted for preterm labor none of the content felt relevant to me.

Happy packing mommies!!

Princess's Bedtime Routine

After Princess came home from the NICU we were busy just trying to adjust to life with a baby and working.  So once we (sort of) had that down I realized Princess didn't have any sort of a routine.  Since babies and kids in general tend to thrive on routine I took to the internet to see what other mommies were doing.  As a nurse I work odd hours and my schedule varies every week so a daily routine for Princess is almost impossible.  However, a bedtime routine is the one thing we could keep consistent no matter the night.  Princess had turned three months old the day I instituted a routine, and it was also the first night she slept through the night (halleluiah!). Since I'm a night owl and the farthest thing from a morning person, I have tried to make Princess a late riser.  If you asked her, 6 and 7 a.m. are still considered the middle of the night (as it should be hehe). Prior to instituting a bedtime Princess wasn't settling into her crib until midnight most nights, which I didn't like.  I started putting her bedtime at 11 p.m. then backed it up to 10 p.m. and now it's 9 p.m. since the time changed and Princess never got the memo (shh!).  Ideally I would like her bedtime to be 8 p.m. but her feedings right now aren't working out to where that's realistic (that would make her last feeding at 6ish p.m. and I doubt she would even make it to midnight in that case).  Additionally, ever since Princess turned four months old she decided she's over sleeping through the night; which is currently killing me.  I'm currently researching why (possible sleep regression or not getting full enough at her last feeding) and trialing ways to prevent it.  If I succeed that will be another post.  However, the following is our current bedtime routine, and it generally gets me until at least 3:30 a.m. with a sleeping Princess (she starts waking every three hours after that):

• Every other night 8-8:30 p.m.:  Bath and infant massage (YouTube it if you want to learn how to do it.  Princess loves it thanks to the OT in the NICU who taught me how to do it).
• 8:30-9 p.m.: Last bottle before bed - we sit in her glider in her room with just a dim table lamp and nightlight on. 
• 9-9:30 p.m.: Bedtime story and rocking afterwards.  I also give Princess her pacifier to suck on for the rest of the night at this time.  She prefers Soothies (as recommended by NICU) and MAM (she can hold onto them a lot better by herself).  Additionally, I turn on her Sleep Sheep (see below) to set Princess into "sleep mode".
• After I've rocked Princess to where she's droopy-eyed I put her in her crib, turn off the table lamp, and let her soothe herself to sleep. 

Cloud B Sleep Sheep

I had read that NICU babies get used to machine lights and sounds and tend to like a little light and sound when they sleep when they come home.  Thus I keep a night light on and use the Cloud B Sleep Sheep.  Princess has always fallen asleep with it quickly, and I would recommend it to all mommies (especially preemie mommies).  I had gotten it for her when I was pregnant because the sheep was cute.  However, once Princess came home from the NICU she was still extremely sensitive to sound.  I had had a crib aquarium that played music but it was too jarring and stimulating for her.  She was too busy paying attention to it to work on falling asleep.  I used it for about a week before I nixed that little item.  So next I tried the Sleep Sheep, and an easily-soothed baby was born! It plays nature sounds (rain, ocean, whale, and heartbeat) that are soft and soothing. Rain and ocean are my favorite.  I'm not too keen on the heartbeat and whale sounds.  The whale is a little scary to me and, as a nurse, the heart beat isn't up to snuff for my liking ;).  It affixes to the crib for safe sleep (see picture).  You can also adjust the volume so it was a lot lower when Princess was just sprung from NICU as opposed to it's current volume.  Also, it has a timer for 20 minutes or 45 minutes.  This is great for extending battery life.  I have yet to change the batteries and I use it on the 45 minute setting every night.  I also turn it on when I put her back to bed after feedings.  I love it so much I bought her the travel-sized one for her car seat and stroller for Christmas.

At the time Princess used to favor her right side and the wall she stared at was pretty plain so I wanted to give her something to gaze at while she was falling asleep.  So I got Princess the Cloud B Twilight Turtle which projects stars that slowly change colors on the wall and ceiling, which is cool to watch.  However, Princess was too stimulated by it, and I had to return it.  I liked it but I would recommend it for an older child.  It was really cute, and I was sad it inhibited Princess sleep.

I hope this helps you and your babies get some better sleep!! Sweet dreams mommies!

*Please note I am not compensated by any items mentioned or store linked here.  This reflects my personal views only.

Cradle Cap

Princess got a bad case of cradle cap (really dry skin on baby's scalp) after she was discharged from the NICU.  Turns out she can't use scented products because the scent was bothering her skin.  I now use Aveeno no fragrance, tear-free, body wash for Princess.  I also use it to wash her hair.  This stuff cleared up her cradle cap within one to two baths! I also use Aveeno 24 hour moisturizing lotion on her body and hair.  My pediatrician said Princess's skin was probably just too sensitive to scented products.  Oddly, ever since I got pregnant with Princess my skin has also been unable to tolerate scented products. 

If switching to fragrance free products doesn't do the trick.  Try rubbing mineral oil on baby's head to exfoliate the scales off, then rinse.  Be warned this can get messy, but other preemie moms swear by this remedy!

Lastly, if these at-home remedies don't work consult your pediatrician!

*Please note I am not compensated by Aveeno.  This is my personal view based on my experiences.

Where to Buy Preemie Clothes

Few, if any, people plan to have a preemie.  So when you birth your miracle baby where do you buy her clothes?  I was quite shocked at how hard they were to find in stores.  And the stores I found them in were sometimes just as shocking.  Most of Princess's preemie clothes came from Walmart and Target.  Walmart carries Carter's and their brand Child of Mine.  Target carries Carter's and their brand Precious Ones.  Carter's stores also have a good selection of preemie clothes but at the time I just never made it to an actual Carter's store.  I later found out Burlington Coat Factory also sells preemie clothes.  Oddly, Babies R Us had hardly any preemie clothes. Even odder, what I did find there was mostly boys.  So disappointing!! Additionally, a relative also found Princess preemie clothes at Gymboree.  My mom would buy Princess preemie outfits online from sites specializing in preemies, however most of them tended to be much larger than her other preemie clothes.  I would say most of those outfits were actually newborn sized, not preemie.   However, if you have a micro preemie none of the clothes you will find in the store will fit them until they are at least 3 lbs.  For those extra tiny miracles I would suggest going online and searching specifically for micro preemie clothes.  Happy shopping mommies!!

*Please note I am not compensated by any of the companies mentioned here, and this only reflects my personal view on content mentioned here.  Additionally, this post reflects only what I could find in stores in Dayton, OH, and availability can vary by location.