If you just gave birth to a premature baby, you may be asking what you should do now? That is a great question. Nobody and nothing could prepare you for such eventuality unless you had previously another premature baby. And, even in such a case, you are probably in a state of disbelief saying oh not again!
In this article, I will advise you on what to do? Many times I see parents who seemed a little bit lost and did not know what to do. Working as a neonatologist with hundreds of parents over the last three decades, I gained a lot of experience and want to prepare you a little for what is to come.
Let’s discuss a few things in no particular order that you should probably consider doing if you have just become a parent of a premature baby.
Take a deep breath.
If you are reading this article, it probably means that your baby is alive, and that is a big thing. You gave life to somebody, and you should be proud of yourself. I know it is difficult for you, but you have to preserve your strength for a long fight. It will help if you are ready for it emotionally and physically. Depending on the degree of prematurity at which your baby was born, your baby may need to stay in the hospital for anyway from weeks to several months and, in some cases, even for a year or longer.
Psychologists compare being a parent of a premature baby to being a soldier on a battlefield. These parents are at significant risk of developing PTSD (post-traumatic stress disorder) or depression. Nowadays, some larger NICUs are aware of that and involve psychologists and social workers to check on parents of a premature baby and provide help when it is needed. Family members, friends, doctors, and nurses need to be on a lookout for any signs of postpartum depression in mothers and alert appropriate professionals to help affected individuals.
Find out if the hospital where your baby is receiving treatment is the right or best place for your baby?
While deciding whether to leave your preemie baby in the current hospital, you need to consider two things:
- Quality of medical care
If you have medical insurance other than Medicaid, you probably know that some hospitals are, and some are not in the so-called “network.” Your copayments may vary significantly depending on where your baby is hospitalized. If this is important to you, talk to your insurance and hospital case management worker to sort this out.
When you realize that you are in premature labor, you do not always have a choice of the hospital where you can go. The ambulance will take you to the closest hospital to you. Insurance may agree to cover all services for your baby as it would have been within its network even if it is not “in-network” hospital. However, it is always better to check it at the beginning. Sadly, hospital charges for care of premature babies may run in hundreds of thousands of dollars.
Also, you need to find out if the hospital where your baby is treated right now is the right one from the medical and quality point of view. In neonatal care, NICUs receive the designation of the level of care.
Level 3 and level 4 NICUs can provide appropriate care to pretty much all types of babies at different gestational ages and with all kinds of complications. Most big level 3 and 4 NICUs will be staffed by neonatologists on-site; however, there are rare exceptions. If it is important to you that there is always a neonatologist available to your baby at a moment’s notice, you should ask about this.
Level 2 NICU typically provides care to babies born at 32 weeks of gestational age or more and without severe or prolonged respiratory problems. There will be considerable variability in how those level 2 units are staffed. Some will have neonatologists, some will have nurse practitioners, and pediatricians will cover some of them. However, if neonatologist is not always available on-site, he or she will be available by phone to consult on more complicated cases.
Level 1 NICU is a place where we take care of healthy term newborn babies. In most cases, pediatricians or family practice doctors provide care to babies staying in level 1 nurseries.
You should ask your baby’s doctor: if NICU, where he/or she is treated, is the right and best place for your baby to be now. You need to ask: if your baby needs a transfer to another institution for further care. Obviously, in all situations, one has to consider benefits and risks for your baby before deciding to transfer it to another institution. You can read more about the NICU levels of care in my article here.
Find out who is your baby’s doctor and primary nurse.
In most hospitals, there will be numerous doctors that will be seeing and taking care of your baby:
- residents (doctors in training),
- fellows (those are sub-specialty doctors in training),
- pediatric hospitalists (pediatricians who provide care in the hospital)
- neonatologists (pediatricians with additional training in the care of newborns and premature babies)
- and many others.
Usually, there will be one doctor with a specialization in neonatology – who will be on service for a week or for a month – who will be responsible for the management of medical care of your baby. You definitely should know who that person is? (You can read more about all medical professionals taking care of babies in NICU in my article here).
After birth, once your baby’s condition is stabilized, a doctor hopefully will come to your bedside and give you all the initial information. He or she will most likely tell you in general terms how sick your baby is at the moment and what to expect in the next few hours and days.
Usually, discussions about long term outcomes are left for later once doctors have a better idea of how your baby is doing and also after you had a chance to recover from stressful moments of delivering a premature baby. You can ask: how often you will be receiving updates and who you can contact if you would like to check on your baby. Usually, the fastest and easiest way of checking on your baby is knowing who is a nurse taking care of the baby during each shift and understanding how to contact her/him directly.
Plan on how to spend time with your baby at his/her bedside.
You will want to be as much in the hospital at the bedside or holding your baby as you can. You will have to consider different factors such as your family situation (any small children that you have) and available family and friends that potentially can help in taking care of your other children and pets and home.
Your job situation may influence your decisions. For most employed people, it is difficult to take extended time off from work. If you have limited time off that you can take, usually the smart thing is to take time off initially so you can spend time with your baby during the first days or a week when your baby is in most critical condition. Save the rest of the available time to you for when the baby is closer to being discharged home. That way, you have time to learn how to take care of your baby’s needs before discharge home from the NICU. Some people will face a difficult decision if they can afford or if it makes sense for them to quit the job altogether.
Consider providing breast milk for your baby.
Breast milk is by far the best and most valuable medication that your premature baby can receive. Take note that I called breast milk a medicine. I’ve done that on purpose. Breast milk is even more critical for extremely premature babies and micro-preemies. If you want to know more about it, watch my video about the benefits of breast milk for premature babies on my NeoPedEdu YouTube channel.
If your baby was born at less than 32 weeks of gestational age, it is unlikely that you will be able to put your baby to breast in the first few days after birth. However, you should start pumping breast milk as soon as you can. Since your body went through very different adjustments comparing to delivery at full term, your body does not know that your baby needs milk right now. You need to pump milk regularly, every 2-3 hours, so your body gets used to it, and you start producing milk.
It will be helpful for your milk supply if you do kangaroo care (also known as: “skin to skin care”), provided your baby can tolerate that. You would be surprised that very tiny babies, even when they are very sick, tend to tolerate kangaroo care pretty well. Many times, they tend to be more stable in your arms than when they are alone in their isolettes not held by you.
Learn as much as you can about prematurity and conditions associated with it.
Knowing the health issues affecting you or your family members is frequently under-appreciated. You must understand well what is going on with your baby. Your knowledge will help you in making decisions about the care of your baby when discussing different options with his or her doctors.
If your baby is an extremely premature baby or a micro-preemie, there will likely be situations when doctors will present you with different treatment options with benefits and side effects to consider.
There are many resources available to you where you can learn more about health issues associated with prematurity. You can start your education with the sites I listed below:
- If you have a premature baby born before 32 weeks receiving treatment in the NICU right now, I encourage you to explore my book “Babies Born Early“
- My website NeoPedEdu: I publish articles about different health issues affecting premature babies, full-term babies, and infants.
- My YouTube Channel
- March of Dimes: A charitable organization that provides education, advocacy, and research funding aimed at prenatal health, congenital disabilities, and genetics: https://www.marchofdimes.org/
- WebMD: An American corporation that publishes on-line news and information about human health and well-being: https://www.webmd.com/
- National Institute of Health: Governmental Organization focusing on research and education: https://www.nih.gov/
- CDC: Centers for Disease Control and Prevention is a governmental agency providing reliable information about various health topics: https://www.cdc.gov/
This article is only for general information purposes. It should not be viewed as any kind of medical advice. There is a small chance that information here may be inaccurate. You should always discuss all health-related matters with your doctor before making any decisions that may affect your health or health of your family members.