Like most first-time moms, Brittany Shives had high hopes for the birth of her first baby. But just about every one of those plans fell apart when she gave birth nearly 7 weeks before her due date -- and wound up camping out in the hospital parking lot while her newborn daughter remained in the neonatal intensive care unit.
Shives was just 33 weeks along and feeling great when she and her husband, Justin, spent a quiet holiday weekend at home. Then at 3 a.m. on Monday -- Labor Day -- everything changed. “I got up to go to the bathroom and, when I got back into bed, my water broke,” she says.
They made the 45-minute drive to the hospital and were rushed right up to the labor and delivery unit. “I assumed they were going to put me on bed rest,” Shives says. “Then one of the nurses informed me that I wouldn’t be leaving the hospital until I had the baby.”
Overwhelmed and Unprepared
That’s when panic set in. “We didn’t even have a car seat yet, we still had two baby showers planned and my maternity pictures were scheduled for later that day,” she says. “I was also scared to death to bring a 33-week-old baby into the world.”
The doctors briefed Shives on everything that might be wrong with her baby -- and then induced her. When Sadie was born, Shives says she was relieved to see that, at 4 pounds and 15 ounces, her daughter was on the “plumper” side for a preemie.
They were able to snap a few photos before Sadie was wheeled off to the neonatal intensive care unit (NICU), where she was attached to so many wires and tubes that breastfeeding was impossible.
Still, the NICU nurses encouraged Shives to start pumping right away to build the milk supply, which experts say is key.
Sadie made great progress during her first week: She was breathing without assistance and steadily gaining weight. But until she could finish her bottle at every feeding during a 24-hour period, she couldn't leave the NICU.
“The thought of going home without Sadie was too much to bear,” Shives says. So when a nurse suggested staying in an RV in the hospital’s parking lot, she found a family friend who volunteered to drive 2 hours to loan her one.
Camping out nearby gave Shives a chance to spend lots of time with Sadie -- and with the NICU staff. “At first it was intimidating to fumble with changing her diaper in front of experts, but then I realized what an amazing opportunity it was to learn,” she says.
After 17 days in the NICU, Sadie was cleared to leave. At home, Shives watched her infant's every move, eager for her to reach every milestone.
“At 2 months, she was a hearty eater and a sound sleeper, but I still hadn’t seen her smile,” Shives says. “And then, at 2 and a half months, it happened -- and I knew that everything would be okay.”
If you find yourself in a situation like Brittany’s, here’s what you need to know.
At the Hospital
Common complications. A preterm or premature baby is one born before 37 weeks of pregnancy. In the U.S., 1 in 9 babies is born too soon, and as many as half of premature births have no known cause.
Generally, the earlier your baby is born, the higher the risk of problems. Most preterm infants will need to spend time in the NICU, where doctors can monitor their body temperature, breathing, feeding, blood sugar -- and watch out for jaundice, anemia, infections, and sleep apnea. If a baby is very premature -- before 28 weeks -- she may have other, more serious issues.
Navigating the NICU. It’s scary to see your baby with wires and tubes attached, but doctors urge parents to get involved with their newborn’s care from the start.
“It helps parents bond with their baby and build confidence,” says Edward McCabe, MD, PhD, senior vice president and medical director of the March of Dimes. If you're worried about working around the equipment, ask the NICU staff for help.
Build your milk supply. If you plan to breastfeed, start pumping as soon after birth as possible. Aim to pump four to eight times a day.
Even if your baby isn’t yet able to feed from your breast or a bottle, breast milk can be given in other ways -- from an eyedropper or a tube -- or frozen for later use.
Premature babies often have a hard time learning to breastfeed, so it's important to be patient and get plenty of support.
Take a trial run. Many hospitals now have a separate room where NICU parents can stay or “room-in” with their baby for a day or two before they’re released from the hospital. This gives parents the chance to practice being the main caregiver while the nursing staff is nearby.
The waiting game. While each case is unique, most doctors will approve the discharge of a baby from the NICU, based on whether or not they can:
- Breathe without help
- Keep a constant body temperature in a crib
- Take all feedings by breast or bottle (not through a tube)
- Steadily gain weight
Even a brief NICU stay can feel like forever. “The last mile of the marathon is the most challenging, and that also applies to premature babies,” says Isabelle Von Kohorn, MD, PhD, a neonatologist in Washington, D.C. It’s also hard on parents.
“In some ways, I like to see this frustration, because it shows that parents are growing more confident in their ability to care for their baby on their own.”
Prepare to Head Home
Before you leave the hospital, take a course in infant CPR.
“Chances are you won’t need to use it, but it’s still a good skill to have,” McCabe says. Ask your baby's medical team any questions you might have and take lots of notes.
When the day comes to bring your NICU graduate home, you’re bound to feel relieved, excited -- and nervous. A little prep will help ease the shift from hospital to home.
Protect your passenger. Check the label on the side of your car seat to make sure the minimum weight is OK for your preemie.
To be safe, your hospital may require you to bring the car seat in for a trial run. During this hour-long test, your baby will sit in the car seat and wear a monitor to keep track of their heart and breathing.
Set a sleep routine. Preemie, or not, your baby should sleep on their back. Get them their own firm mattress, and put it in your room. This helps with bonding, feeding, and lowers the chances of sudden infant death syndrome (SIDS). Also make sure there are no soft objects in the crib with them.
Pre-term babies tend to sleep more hours per day than full-term babies, but they also wake up more often. “Be prepared to soothe your baby several times during the night,” says Deborah Donohue, RN, a former NICU nurse who now travels the country as a private baby nurse.
Know how to soothe your little one. Preemies can be extra sensitive to noise or touch. Sometimes the best place for them is on their parents’ chest. This skin-to-skin contact -- also known as kangaroo care -- helps keep stress levels down.
“Remember, they had you close for 9 months,” Donohue says. “They still need to be close.”
A familiar voice will also be soothing to your baby. Talk to them in a gentle tone or sing lullabies.
Stick with the NICU feeding times. “Premature babies usually come home on a schedule -- stick to it,” Donohue says.
Most infants need to eat every 1-3 hours around the clock for the first month. Preemies tend to eat smaller amounts and may have reflux, Donohue says. Holding your baby upright after a feeding can help.
Your doctor may suggest a supplement with vitamins, iron, and a special formula if the baby is bottle-fed. All breast-fed infants need extra Vitamin D. Try not to breast feed while you are tired. If you do, avoid feeding while sitting in a chair or on a couch in case you fall asleep.
See your pediatrician often. Schedule a visit with your baby's doctor for a few days after you get home. Set up weekly appointments for the first month.
These medical checks and weigh-ins after are important for preemies -- and reassuring for parents.
Measure milestones. To chart your premature baby's development, your doctor will use their corrected age. That’s the age in weeks minus the number of weeks she was premature. So, if your baby was born 8 weeks early, at age 6 months their corrected age is 4 months.
But preemies get shots at the same ages as full-term babies. Most catch up to their peers developmentally in 2 to 3 years.
Keep traffic to a minimum. “It’s nice to have visitors -- especially ones that bring food, clean the house, and take care of siblings,” Donohue says.
Just don’t overdo it. They should always wash their hands and should limit or avoid touching your baby. Anyone they come into contact with should be healthy and fully immunized.
Take care of yourself. When you’re focused on your new little one, it can be easy to neglect your needs. Ask your friends and family for help. Make the most of outside resources.
Take good care of yourself, because that will help you take the best care of your baby.