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What Happens in the NICU? An Expert and Parents Share Their Experiences

Having a premature baby can be bewildering, scary and stressful. It can also be quite a surprise. Not only do you lose months to prepare mentally and physically, but you’re suddenly thrust into a world where you have to make urgent decisions.

According to the American Academy of Pediatrics (AAP), premature birth occurs in approximately 11 to 13 percent of U.S. pregnancies. Babies born prematurely – less than 37 weeks – may have health issues and need to go immediately into the Neonatal Intensive Care Unit (NICU) after birth.

Some parents say that one of the hardest parts of having a premature baby is coming home to an empty nursery while baby is still in the hospital. “There will be days you sit in the hospital parking lot crying in your car because you cannot stand another minute without your little one [coming] home with you. That is OK,” says Sarah Mehan, a Florida mom whose daughter was born at 32 weeks. “You did not fail. You did nothing wrong. They will be home soon, and it will get easier. You just need to hang in there a little longer.”

Christina MacArthur, a Utah mom, had a son born at 35 weeks. He's three now, but she still worries. "I check in on him at night to make sure he's breathing. I make sure I hold him all the time and smother him with love since he spent so much time hooked up to wires and machines [in the NICU], and I was unable to hold him at first."

The NICU “is a crazy roller coaster world full of bells and whistles, frightening alarms, huge pieces of equipment and tiny humans fighting to survive,” says Dr. Terri Major-Kincade, a Texas-based neonatologist and author of Early Arrival: A Parent’s Guide to the NICU. Knowing what to expect can make navigating this world easier.

After speaking to Major-Kincade, other medical professionals and experienced preemie parents, Huggies wants all parents to know what to expect in the NICU from the experts.

Please note: This is not medical advice. Every birth and baby are different, so you should speak to your doctor if you have any questions or concerns. This information is a general guide of what you could encounter. 

What happens right after birth?

“Our main priority is to make sure the baby can breathe so we can stabilize the heart rate,” says Major-Kincade. “If the baby cannot breathe, the heart rate will remain low or begin to drop. This is a scary moment for parents because everyone wants to hear their baby cry in the delivery room. For preemies, many times they will not [cry] because we have to put a breathing tube in the mouth behind the vocal cords.”

This happened to MacArthur and her son. “They placed him on me to cut the cord, and he was completely blue. He did not cry at all. They immediately hooked him up and ran him to the NICU. I was not prepared in any way for what happened. Nobody warns you or preps you for a preemie,” she says.

Will you get to see your baby right after birth?

It depends on the health of the baby, according to Kelli Kelley, the Texas mother of two premature babies and founder and executive director of Hand to Hold, a support organization for families with a baby in the NICU. “My 24-week-old was critical, so I did not get to see or hold him,” says Kelley. She was still under anesthesia. Kelley says that with her second birth, “my 34-week-old was shown to me, but whisked away to be assessed in the NICU.” 

Mehan was a little luckier. “Abigail was born at 3.8 lbs. via emergency C-section. She was weighed and cleaned up in the birth room, then I was able to kiss her -- not hold her -- and she was taken out for further evaluation,” she says. It would be another 24 hours before Mehan would see her baby again. "This was due to issues I had with my C-section, but my family was able to see her right away.”

Where does your baby go next?

Once the heart rate and lungs are stable, Major-Kincade says the baby is quickly taken to the NICU nursery. “We want to make sure the baby does not become cold; getting cold significantly affects the baby's survival rates,” explains Major-Kincade. It can be a frightening, uncertain time for moms and dads, she notes, “because we rush out of the room with the baby and lots of equipment, and they may wait many hours before being able to see the baby or to receive an update.”

Major-Kincade says that every child in the NICU is assessed for stability, which may require different tests, equipment, and procedures. These may include an IV, an X-ray (to determine what is happening with the lungs), and a respirator to help with breathing. She adds that, when parents are invited into the NICU for an update, they have to wash their hands at a scrub sink and may have to wear a gown before going to the incubator or warmer to see their baby.

Visiting your baby in the NICU can also depend on the health of the mom. Kelley, a member of Huggies Nursing Advisory Council, had to wait several hours to see each of her preemies as she recuperated from her C-sections both times, while her husband followed the newborns to the NICU. “Many hospitals will take photos of the baby in the NICU to give to moms that are medically unable [to go there],” she explains.  “They can also bring moms in their hospital beds if needed. Some hospitals even provide cameras in the NICU, so parents can see their baby remotely.”

What will your baby look like?

“If it is a very small preemie, less than 24 weeks, or a pound or less, parents can be really traumatized," says Major-Kincade. "Their baby may not look like a baby. They are tiny. Their skin is shiny. Their little chest goes in and out and they may be struggling to breathe. We try to get the parents to touch the toes or the fingers [through openings in the incubator] and sometimes the baby will grasp a finger. It takes parents many visits to get used to the way their baby looks.”

What is the process for feeding?

“I nursed and pumped and Abigail was bottle fed with breast milk and formula because she needed the extra calories,” says Mehan. However, every baby’s situation is different.

MacArthur couldn’t see her baby for about 12 hours, and she couldn’t start breastfeeding for three days while he was in the NICU. During that time, she pumped and froze her milk. “They would swab my colostrum and then breast milk onto his gums so he could start tasting and smelling my milk. He was unable to nurse while on the ventilator, so he was fed through a feeding tube.”

When can you hold your baby?

Many premature babies are too fragile to hold right away. Plus, they are hooked up to a lot of equipment. But the power of touch and bonding with their parents is very important.

For one of her son’s first week of life, Kelley couldn’t hold, feed or even change his diaper. She whispered prayers over him and told him that she knew he was a fighter, even at only 16 weeks. When she could finally change his diaper, “I was excited, nervous and scared because he was still very small and his skin was as fragile as wet paper.”

She didn’t get to hold him for six weeks, though. With larger preemies, it can be much sooner. “We know there are mental and physical benefits to skin-to-skin contact, so most hospitals work diligently to get the baby into the arms of the parents as soon as possible,” explains Kelley. 

What happens next?

Sometimes mom is ready to go home, but the baby isn’t. “The one thing a mother will never be prepared for is leaving the hospital without her baby,” says Mehan. “That is the hardest part, but it will get easier. You will learn to trust that your daughter/son is in the best care, and the entire staff -- as well as your little one -- is working to get them home.”

When can you take your baby home?

There is no single answer to when baby is ready to be discharged, says Kelley. "It depends less on weight and more on when the baby is able to regulate their body temperature [outside of the incubator] as well as suck, swallow and breathe [on their own] when feeding."

MacArthur’s son, like most babies born prematurely, was required to pass a car seat test to guarantee that his oxygen levels wouldn’t drop and he wouldn’t stop breathing during the ride home. “And I had to drive four hours,” she adds.

How do hospitals prepare you for taking home your preemie?

Parents have to learn how to feed and care for their premature infants on their own, how to administer medications and other routines performed by nurses. They may also be trained in infant CPR and learn the signs of distress before the baby is released.

Major-Kincade says some hospitals let parents room in the NICU for a night or two, giving them the opportunity to be in charge of their baby’s care while still having support from hospital staff. When you’ve been dependent on monitors constantly checking baby’s vitals, “it can be very hard for parents to leave the monitors,” she says. Some babies may have to go home with a monitor or oxygen, and parents will receive training on how to use the equipment, as well. 

Where can you get help?

For more advice on how to cope during this difficult time, talk to your doctor and the NICU nurses, and reach out to other parents. Helpful information, resources and one-on-one support from other preemie parents can be found at at Hand to Hold, an organization that helps families before, during and after a NICU stay.

You can learn more about the power of human touch for babies and the Huggies No Baby Unhugged Program here: https://www.huggieshealthcare.com/en-us/power-of-hugs/human-touch-for-babies


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