A Parent's Guide to Surviving the Neonatal Intensive Care Unit (NICU)

Nothing is more joyous than a newborn baby. Nothing is scarier than one that decides to come early. When a baby is born earlier than 37 weeks gestation they are considered to be "premature." Premature babies spend days, weeks or even months in a NICU, or a Neonatal Intensive Care Unit.

For mothers, the first thing you need to accept is that in half the casesof prematurity, there are no known causes according to the March of Dimes. Do not blame yourself. There are times when an infection may be present and for the baby's safety the birthing process starts. Other possible causes may be drug use, sexual activity or multiple babies. Just know that half the time it just happens. You have to trust that nature knows best and for whatever reason, baby just needed to come out early.

When the birth happens, the hospital staff may try to stop it. They may give you a muscle relaxant to slow down the contractions. They may give you a cycle of steroid shots to help speed up the baby's lung development.

When you first see your little one it may only be for a moment before the Premature babies are subject to X-rays, drew blood and performed and the standard Apgar test. You may or may not hear a little cry.

First Visit

Before walking into the NICU, you will be required to both wash and sanitize your hands. Most hospitals now have very secure systems for NICUs and nurseries. You and your partner will be issues a bracelet or I.D. which has a number matching the babies. The NICU may even had a monitor on the baby and alarmed doors to notify the staff if anyone moved the baby.

A staff nurse will check your I.D. and your partner's before you will be allowed to see the baby. This is procedure, and it is necessary for the protection and safety of your baby. In effort for further privacy, the NICU also does not want parents to go any cribs that is not of their own baby's.

There are usually quite a few nurses and doctors on staff in a NICU and the nurse on shift will introduce herself to you. The nurse will go over any issues or concerns that you have and will explain why the baby is in the NICU. In the particular NICU we were in, parents were allowed to read the baby's chart and were encouraged to be present for the doctor's rounds.

As I sat there on a high stool on that first morning, my boyfriend and I held hands and just stared at our little guy. We were lucky, because he was 4 1/2 pounds and 17 inches long, which is pretty decent sized for a "preemie." Since it was a busy summer, our baby was not in an incubator, as they had run out, so he was just resting in a plastic bed with padding and blankets. An oxygen tank stood nearby.

Walking over to a plastic incubator and seeing my little boy with tubes and wires everywhere was physically shocking. Tears immediately welled up. Emotionally I was torn. Intellectually, I knew that most of the tubes and wires were not that serious. He had a C-Pap in his nose to push air in and help strengthen his lungs. He had an IV for nutrition. There were quite a number of monitors on his chest to monitor his heart and his breathing.

Going Home Without Your Baby

Even harder than seeing your baby in the NICU for the first time is being discharged without him or her. A few days ago you were admitted to the emergency room with a big belly full of baby and hope in your eyes. Now you will be going home without that bundle of joy.

The only comfort you have is knowing that the baby is in the best possible place he or she needs to be right now and is receiving around-the-clock care. Program the NICU phone number into your cell phone and call to check on your little one. You will be required to give your I.D. number again and will speak to whichever nurse is caring for your baby on that shift.

When my son was in the NICU I would call first thing every morning. When I first woke up I would want to just get in my car and go to him. Hearing encouraging news made it a little easier for me to take care of myself before bolting out the door to the hospital. I needed time to shower, to eat breakfast, and to pump (breast milk).

When you call the NICU there are some questions you will find yourself asking. A general question is a good place to start: "Did he/she have a good night?" The nurse will usually go from there, guiding you through what you need to know. He/she will discuss the baby's weight, any visits by the doctor, and the baby's vital signs. They will probably ask you when you are coming in next. I spent every morning and afternoon at my baby's side while he was in the NICU. When my boyfriend got home we would also visit in the evenings.

Take Advantage of This Time

There are some unforeseen advantages to going home without your baby, as painful as it is. You will get some much needed sleep, which you will need when baby does come home. Take advantage of this now. Once baby is home, he or she will still be on the NICU schedule, in our case it was feeding every four hours. It took another three months to break him of this habit, so rest now while you can.

You may also not yet have baby's room ready for him or her or maybe baby came before the baby shower. Take time to do this now, or add your finishing touches. Make purchases of the basics you will need for baby and for the family. Doing things for the baby while he/she is in the hospital will lessen your sadness. Because, yes, every time you walk out of the hospital after a visit, or walk back in the house, you will feel the empty place where baby should be.

If the emotional stress is too much, be sure to speak to the NICU advocate or social worker if there is one available to you. Most health insurance's also cover therapy and counseling, which may help you through this. It is difficult to carry around a baby for months and then be without him or her. Friends or co-workers may see you and notice your belly is gone and don't see baby. Explaining what happened over and over again can be stressful. Reassuring family members can also be taxing, as you are not completely reassured yourself.

Know that your partner is also going through an emotional time and you need to support each other through the stress. For most men, they don't like problems they can't fix. Your partner is feeling as helpless as you right now. Is there a crib or changing table that needs assembling? Give Dad something productive to do so he will feel like he is helping.

Simple things like finding time to cook dinner between work (for him if you are still on leave) and hospital visits can be daunting. If friends or family members want to help you, ask them to cook for you, something that you can put in the fridge and heat up. You will not enjoy sitting in a restaurant while baby is in the hospital and cooking takes away from visitation time.

Nursing a Premature Baby

For mothers who have decided to nurse, a premature baby poses a bit of a hurdle. Most breastfed babies can start breastfeeding moments after birth and continue during the hospital stay. For premature babies, they may not be strong enough to eat through their mouth yet. This should not discourage you from providing breast milk for your baby. Premature babies especially need the nutritious and disease-fighting breast milk.

Mothers of premature babies who will breastfeed need to start in the hospital. A Lactation Consultant will hold a class in the hospital that you should attend. Most of the class will focus on actual breastfeeding, which you can start as soon as the nurse says it's okay. A nurse can also help you get started with a breast pump to encourage milk production. A benefit of this will be a quickly shrinking uterus and belly shrinkage.

This is the most rewarding thing you can do for your premature baby, both while you are in the hospital and when you are at home. A nurse will suggest a pumping schedule, and you may start off at every two hours to get the milk flowing. Once you have a good flow, you can go to four hours, as that is when baby is used to eating. The longest you should go between pumping is six hours.

When baby is strong enough to feed by mouth, the nurse may use a tube to feed your baby. Do not be alarmed by this. It will bring nutrients directly into baby's stomach and it means the baby will be getting less through an IV. The next step will be to feed baby by mouth with bottle and or with direct breastfeeding.

Advocating for Your Baby

Keep in mind that although you are not the "expert" on the NICU, nobody can speak up for your baby like you can. Do you have concerns about baby's care? Is baby being rushed out of the NICU before he or she is ready just to make room for more babies? Is mouth feeding being delayed for too long? Do not be shy about the health and welfare of your baby. Discuss any and all concerns with the doctors, the nurses and any social workers or patient advocates on site. The staff may know what is medically right for your baby but only you know what is best. After all, you will know your baby better than anyone after sitting at his or her side of hours on end, and maybe for weeks.

There are a number of factors which determine when baby can finally go home with you. Once doctor's are satisfied with any medical conditions, there are a number of basic requirements baby will need to meet in order to find his or her way home. Baby will get a hearing test. While in the NICU it is normal for baby to lose a bit of weight. Baby's weight will need to be back at least where it was when he or she is born before going home. Also, baby will need to be able to maintain his or her own temperature without the aid of an incubator. Baby will also need to be able to be fed by mouth. Some NICUs keep babies until their due date, although with the increase in the number of premature births, the hospital needs the space for the most recently born babies.

It is hard to not experience the "normal" experiences of motherhood. Not being able to hold your baby in your arms after birth, not being able to nurse them for their first meal outside of the womb, not being able to take your baby home with you. You may also not get that first picture or videotape, and you may not even have that first footprint as a memento. For premature babies, their health supercedes mementos. But don't worry. There will be plenty of time for pictures and memory-making.