A Premie: A Surprise Parents never Expect!

The baby was so tiny - a mere 3 1/2 pounds. Alexa and Albert were not expecting their baby for six more weeks. He was now in the NICU (Newborn Intensive Care Unit), hooked up to various beeping machines, long thin tubes, and shiny gadgets. Though the doctors were saying that little Fredi would be home in a few weeks, Mom and Dad could hardly imagine this. "How could we ever know what to do without the nurses to run all the machines!" Alexa declared.

Sarah had been a NICU nurse for twenty years. She had witnessed the amazing ability of medical technology to contribute to keeping babies alive and eventually sent home healthy. Interestingly, she had noted a worrisome tendency in both staff and parents in these units - to watch the machines more than the baby. Her job was to increase her unit's sensitivity to how much a tiny baby can communicate about himself.

If the NICU lights were suddenly turned up, little Fredi sent his hand up in a "salute" as if to cover his eyes. Beeping of the machine beside him would cause Fredi's face to turn pale and the tip of his nose to go almost white. Having his temperature checked and his diaper changed could cause his heart rate to go up and his breathing to increase. He might arch his back, hyper-extend his legs, and jerk his arm outward. A hand which had been resting almost in a grasp would suddenly splay open.

Fredi is smart. He can talk with his body, and his parents quickly learned to read this important language. The NICU staff "clustered" his care so that he could rest longer between activitie. Mom held him Kangaroo style on her chest so that he could sleep deeper, and everyone learned to speak quieter and less often around his isolette. Premie babies who are cared for in this "developmentally appropriate" way gain weight faster, have less slowing of their heartbeat, leave the NICU sooner, and have fewer long-term consequences of coming into this world a bit too soon.

Learning to watch their baby instead of the machine gave Alexa and Albert just the confidence they needed. Four weeks later they left the hospital with a healthy baby, nursing well, and well on his way to claiming his spot as the new prince of the family!

Kangaroo Care Helps Mom and Baby

Josie, the local nurse midwife, delivered Mary's baby, Sharon. Sharon was Mary's first baby and was born full-term and weighed a healthy 8 lbs, 4 ounces. Josie has a great reputation for "getting any baby to breastfeed," so Mary felt she was in capable hands.

Immediately after birth Sharon was placed on Mary's stomach while the midwife waited a moment before cutting the umbilical cord, thus allowing a final surge of healthy blood to go to Sharon. After cutting the cord Sharon began her second remarkable journey. She started to squirm and wiggle, as if drawn by some magical pulley up toward her mother's breast. While Mary caught her breath, Sharon found her way to her mother's nipple and began to suckle. Mary's first experience as a breastfeeding mother was bathed with the knowledge that her baby also knew that breastfeeding was best and just how to do it. They were off and running as a breastfeeding duo.

Mary spent much time over those first few days with Sharon lying against her chest. This regular skin-to-skin contact (often called Kangaroo Care) has been shown to be a central ingredient for successful breastfeeding. The smell of the mother's milk, the warmth of her breast, the familiar sound of mom's heartbeat comfort a newborn who has just entered a strange new world. Likewise, the feel of the newborn's skin, the smell of her fuzzy head, and the warmth of the baby's breath against her mother's skin sends the breastfeeding hormones surging.

Kangaroo Care really works! Kangaroo Care: causes mothers' oxytocin to increase, enhancing attachment and breastfeeding; causes infants to cry less often and for shorter periods of time; improves mother's and baby's sleep, and helps infants who need the NICU to go home sooner and with better weight gain.

Research recommends skin-to-skin embrace immediately after birth, thirty minutes before the second and third breastfeeding, and six hours a day for the first week of life. This special contact enhances a mother's efforts to breastfeed successfully. Some breastfeeding-friendly women have created clothes for mothers which facilitate the mother staying comfortably skin-to-skin with her baby. (Thanks to preciousimagecreations.com for their creations for new moms and for use of this photo.)

So next time that baby looks up at you with those big eyes that say, "Give me some skin," you'll know she has a good idea!

She's Sleeping like a Baby - But Mom's Not!

As Julie walks in for her newborn's two-week-old visit, she declares, "I've had it!"

"I'm quitting breastfeeding. I'm exhausted. I nurse little Taylor and put her down to nap. Forty-five minutes later she starts to squirm around. She smacks her lips, her eyes flash open, and she whimpers. I figure she's ready to eat again, so I get her to the breast. But she immediately falls asleep. It takes me (and my husband!) another hour to wake her up to eat. Then it starts all over again. I know breastfeeding is best for the baby and me, but maybe I need to quit!"

I am delighted that Julie is telling me this story before she stops breastfeeding. Hers is a problem I can solve by sharing just a little more information.

Julie is confusing her baby's "light/active sleep" and her baby's waking "zone." (See the video clip at http://www.hugyourbaby.com/sleeping.html) All babies have two sleep cycles. Deep/still sleep is easily recognized as a baby fast alseep: She is totally still, her breathing is deep and regular, her eyes stay shut and still under the eyelids, and she doesn't make any noises. That's the kind of sleep people refer to when they say, "She's sleeping like a baby!"

Light/active sleep looks very different. In light/active sleep the baby will stir, jerk his arm or leg, breathe more rapidly, flash his eyes open a moment, make sucking movements with his mouth, and grunt or make other newborn sounds. Such a baby seems like he's waking up, but, in fact, he is still asleep. All babies cycle between these two sleep zones a number of times during the night.

Julie is relieved. She returns for a weight check the following week with a big smile on her face. She reports learning to recognize her baby's light/active sleep. When Taylor gets to that zone, she leaves her alone and in a few minutes the baby goes back to deep/still sleep. Mom gets to sleep another hour or two. When Taylor is hungry, she transitions from that light/active sleep to waking up. After she cries for a minute or two, Julie knows that now she's really ready to eat.

Julie's breastfeeding is going great now, and she has become very popular with her neighbors by sharing this information. The whole neighborhood is sleeping better!

Babies Act their Age not their Weight!

Rhonda and Frank brought in their 5-day-old son, Joey. They were worried. Though Joey weighed 7 pounds at birth, he was born at 35-weeks gestation (five weeks early). The hospital was slam full on his birthday, but since Joey "looked good," he was sent off to the full-term nursery. The lactation consultant had watched him nurse for a few minutes in the hospital, and Mom had come home determined to provide only the best--breastmilk--for Joey.

But something wasn't going right. Though Joey had a number of wet diapers before he left the hospital, it had been eight hours since he'd had another. Rhonda said he seemed sleepier than before and would only nurse about 3 minutes before getting tired and falling off the breast.

In past years Joey would have been considered a "Near Term" infant and treated as a full-term baby. Now, however, he is considered a "Late Preterm Infant" if born between 34 and 37 weeks gestation. These babies are at higher risk for important problems which need to be carefully assessed and treated.

We knew how to keep Joey out of trouble. Anticipating possible difficulties with with blood sugar and yellow jaundice, his levels were checked and followed. Since babies are usually 36 weeks gestation before their sucking and breathing is fully coordinated, we helped Rhonda nurse Joey, then showed her how to pump her milk and give it through a special gadget called the SNS (Supplemental Nursing System). This device helped Joey take the breastmilk without as much effort while not interfering with his learning to nurse effectively. The pump also helped Rhonda's milk supply increase as Joey became more able every day to be a fully breastfed infant. We saw Rhonda and Joey daily and monitored his weight, pees, poops and necessary blood tests. By ten days old, Joey was heading back toward his birth weight--and nursing well.

There has been a 31% increase in pre-term babies in the past two decades and a 40% increase in Late Preterms. This increase can be attributed to women having babies later in life, more infertility treatments, more twins (and other multiple) births, and perhaps an association with obesity in the mother.
What you can do to care for a Late Preterm baby:

1. Follow guidelines for preventing prematurity.
2. Since knowing the exact time of conception can sometimes be tricky, clarify at birth if your baby is Late Preterm. (Your health care provider can do this using The New Ballard [Physical] Exam.)
3. Get careful instructions on how to watch your baby the first few weeks of life.
4. Get help immediately if your baby seems too sleepy, does not nurse well, or is not peeing as expected.
5. Request that your health care provider follow the newest guidelines for care of Late Term Infants.

(http://www.marchofdimes.com/prematurity/21239_5809.asp
http://www.medela.com/NewFiles/specialtyfdg.html#startersSNS
http://www.marchofdimes.com/files/MP_Late_Preterm_Birth-Every_Week_Matters_3-24-06.pdf
(http://pediatrics.aappublications.org/cgi/content/abstract/118/3/1207)

Being a Parent is a TALL Order!!

I call them the "TALL Family." That's because when they enter the exam room, Mom, Dad, and both grandparents tower over me. They're all over six feet tall. As they place their very LONG baby onto the exam table, Mom suddenly bursts into tears.

"He hasn't stopped crying since we got home," Mom weeps. "It's been four very long days. We waited so long for this baby, and now we must be doing all the wrong things!"

Sabrina had indeed waited a long time--three miscarriages, two years of infertility work-ups, and then, at last, little (and long!) Jakie.

I start Jakie's physical exam. When I check out his hips he starts to fuss. Eight eager arms reach out immediately to comfort Jakie. But he seems to cry even more. The next time he cries, I suggest that we add a new ingredient to the mix. "Let's watch him just a second when he cries and see what happens."

I turn Jakie over to check his back and he starts to fuss. I then lie him gently on the table and talk softly over his face. "Little Jakie, can you help calm yourself down? Are you listening, little Jakie?" Jakie pumps his arms a second, then hesitates, then looks off to the side and stops crying. He looks relieved, as do his parents and grandparents. Mom then swoops up Jakie in her arms with a big smile and a hug.

Parents who have suffered much loss before the birth of a baby often see their young one as very fragile. For parents such as these it is especially magical to be able to see their newborn participate in calming down. Parents then see his capacities, his abilities, and his strength.

Two weeks later I saw the "Tall Family" again. As Mom was leaving the waiting room, she told me how calm and happy Jakie is. "We're a team now. We help him, and he teaches us every day how to be the parents he needs us to be."

Mom glowed as she marched out. She looked ten feet tall!

Don't Dare Stand between a Mother Bear and her Cub!

Sally is a busy lady in our community. If something needs to be done, call Sally! It was no surprise, then, that when Sally came to see me after her first prenatal visit, she had some new and important questions.

"Why don't we have one of those 'Baby-Friendly Hospitals' in our area?" she queried. "I've been trying to decide which hospital I want to have my baby in, and not a single one around here is 'Baby-Friendly'!"

She's right. We live is a huge tri-city area with six large hospitals within 20 miles of one another, but none have sought the prestigious and important "Baby-Friendly" credential.

Created by UNICEF and the World Health Organization in 1995, this designation identifies hospitals that demonstrate their commitment to breastfeeding by taking ten logical steps including: educating the staff about breastfeeding, developing a breastfeeding policy, giving no formula supplements (unless medically indicated), practicing rooming-in (having the mother and baby sleep in the same room), etc. But perhaps most important of all, "Baby-Friendly" hospitals agree to stop giving out formula in those so-called "gift packages for new moms." Research shows that these "gifts" of formula contribute to women giving up breastfeeding. A "Baby-Friendly" hospital has to be willing to pull this financial plug. http://www.babyfriendlyusa.org/

"Write 'em a letter, call the hospital, tell your OB, your pediatrician, and your friends!" I remark. And when Sally takes these actions, she will join other dedicated lactation consultants, nurses, and parents who understand that breast milk is best for babies and that new moms deserve the best help available as they learn to breastfeed.

Everyone knows not to stand in the way of a mother bear and her cub. Hospitals better watch out! I've seen Sally in action. She will fight to make breastfeeding support available for herself, her baby and other young families in our community.

A Soldier is Birthing Babies...and Getting Dads on Duty!

I admit I was suspicious when I saw that a man was listed as a speaker at the "Art of Breastfeeding" conference. He is not only a Certified Nurse Midwife but also a lactation consultant! And he does it all for the US Army.

Maj. Jarold Johnston was an inspiration as he described his philosophy and the techniques he uses to get dads-to-be to participate fully in the breastfeeding experience. "Sometimes it helps that I'm a soldier. I just tell the dads: 'Moms have a job, babies have a job, and dads have a job too. Get on with it!'"

Maj. Johnston believes that his job as a breastfeeding expert is to teach dads to be the in-home expert. "Dads have a good vantage point. The new mom is looking down at her breast and the baby, but the dad can see the mom's nipple, the baby's chin, the baby's cheeks from the side, the bottom, or the top - whatever it takes." "Most Army guys are mechanically inclined," he explains. "They like the challenge of figuring out the mechanics of what's working or not."

Mothers love the help. Dads might get good at changing diapers, but a "breastfeeding dad" has more important things to do! "Besides," Major Johnston says, "I tell them the truth - a successful breastfeeding mom resumes sexual activity quicker than do bottle-feeding moms...Yep - even the 82nd Airborne is on board now!"

Have You Noticed? Dads and Moms Interact Differently with Their Babies!

Terry is an energetic, seventeen-year-old dad. He is the quarterback and a senior at the local high school and comes to the office today with his girlfriend, Diane, and Eric, their three-week-old son.

Terry remembers what he learned on The HUG DVD. He holds his son like a football then places him enthusiastically on the exam table for his check-up. Diane laughs as Terry starts to poke at his son. First he pokes at his feet, then his knees, then his stomach, then his nose. Eric starts to breathe a bit faster and his feet start to look jerky. His eyes spring wide open, his eye brows rise, and his shoulders go up toward his ears. "I'm ready for you, Dad!" his body seems to say.

Dad steps back from the exam table as Mom reaches over to undress Eric for his exam. As she moves toward the baby, Eric's eyes start to look drowsy and his body relaxes. His movement slows down and his breathing quiets and becomes regular.

Though certainly their are differences in individual parents and babies, Eric demonstrates what research now shows, that dads and moms approach babies differently. Even fathers with childcare experience often approach a baby with big, enthusiastic movements. Their very presence seems to stimulate the newborn, as if to get baby ready for the big world out there.

The more stereotypical mother's approach is quieter, one that seems to calm the baby rather than stimulate him even more.

Babies benefit from both approaches as they grow and learn, suggests psychologist Kyle Pruett. They may learn to regulate their internal stimulation from one parent, and learn to deal with external excitement from another. (Fatherneed: Why Father Care Is as Essential as Mother Care for Your Child.) Most mothers and fathers experience some conflict as they struggle to love their baby in the best way they can. It's the lucky baby whose parents approach this struggle with passion and humor as they each become the parents they were meant to be.

(Read more sotries about new babies and their parents!)

"He is looking for his REAL Mother!"

Susan looked at her baby lying in her husband's lap. Instead of that overwhelming sense of joy she expected, she instead felt fear, apprehension, that deep down worry that "I am over my head here." Susan's baby was born two weeks ago and Susan, the adopting mother, and her husband were in the delivery room.

Sammie was born full-term, robust, and healthy by all accounts. But whenever Susan would hold and talk to her newborn, he would turn his head and look the other way.

"I think he is looking for his real Mommy!" Susan confesses in tears during this first well baby check-up.

Susan is a first-time mother who comes to motherhood through the long and turbulent road of infertility, disappointment, and ultimately (and thankfully) to adoption. Her feelings of insecurity are normal, but unfortunately, her interpretation of her baby's behavior is mistaken.

Sammie is not "looking for his real Mommy." He is instead demonstrating a normal newborn behavior call "Switching Off." (See video clip at http://www.hugyourbaby.com/skills.html) Some babies who are slightly over-stimulated may actually turn away from an enthusiastic mother's talking face. This ability to "Switch Off" is actually a sign of Sammie's amazing ability to keep himself from being over-stimulated. He looks away from Mom for a second to keep himself calm.

Susan is startled to learn from Jan that "Switching Off" is a sign of Sammie's competence, NOT his rejection of her mothering. She is encouraged to stop speaking to Sammie for a few seconds if he "Switches Off." Right there in the exam room Susan practices this advice. When she stops speaking and just looks at Sammie, he holds her gaze. In this moment of mutual sharing a new step toward bonding to one another occurs. Susan now knows that Sammie IS looking at his REAL Mommy--right now!

Walking on Holy Ground!

Why do I write this blog? I ask myself.

I've been a nurse practitioner for thirty years. During that time I've experienced lots of amazing moments, participated in many challenging situations, and had my share of scary experiences. But when I think of what touches my heart the most, it is sharing a family's life with their new baby. Perhaps the need for folks like me stems from the fact that many young families have no extended family nearby. They make phone calls to Kansas, Seattle, or Hong Kong. Sometimes the needs are even greater. Last week a young woman told me, "I feel silly asking you this question, but my mom is dead, so who do I ask for help?" Who is there to share that baby's first smile, to hear that new mother's worry, to give a hug after the grand effort to keep a newborn on the breast? I guess that person's me, a lot of the time.

I often feel like I'm walking on holy ground. I find myself taking a deep breath before I respond. Simply answering a question might in the long run make the questioner feel less secure as a parent. Giving parents skills to discover their own answers is what I believe my job is.

A few months ago a mother of a two- and a four-year-old left the office after her kids' check-ups. "You always make me feel like I'm such a good mother!" she said as she corralled her energetic children and headed down the hall, out the door, and into the world. "You always make me feel like a good nurse," I replied as I grabbed my next chart and headed off to another patient encounter.

I'm All Ears!!

Regina and her friend, Rochelle, were both pregnant with their first babies. Regina had read about an experiment done with pregnant ladies and told Rochelle about it. They decided to try the experiment themselves.

During the last six weeks of their pregnancy Regina read The Cat in the Hat to her baby every evening. Rochelle read The King, the Mice, and the Cheese each day. Their babies were born within three weeks of one another.

Regina and Rochelle met for coffee to try out their "experiment."

Regina started by reading The King, the Mice, and the Cheese to her baby. The baby boy raised his eyebrows a bit when she started reading, but nothing more. Then she began to read The Cat in the Hat and her son got excited. His eyes got bright, his arms started to pump, and he looked around as though he were looking for "his" book.

Rochelle's baby was sucking her pacifier contentedly and seemed ready for her "experiment" to began. When Rochelle read The Cat in the Hat her daughter seemed to relax as if ready to drift right off to sleep. However, when her Mom began reading The King, the Mice, and the Cheese the baby girl alerted and increased the pace and intensity of her sucking. Her eyes widened with a wise "I-know-what's-going-on-around-here" look on his face. "That's MY book!" she seemed to say.

Babies hear both in utero and out. Other studies have shown how they will suck harder on a pacifier to hear a recording of their mom's voice vs. another woman's voice. They prefer to hear their family's language rather than a foreign language. They love that high-pitched, sing-songy voice grown-ups instinctvely seem to use with babies.

So the next time you are hanging out with a newborn--or with one on its way--just remember, "I'm all ears!"

Chin Up

Steve, Isaiah's father, is with me for his son's two-week weight check while his wife's blood pressure is checked next door.

As Steve starts talking to Isaiah, the baby at first tilts his chin up toward his father. But, the baby's eyes soon glance off to the side. Steve calls Isaiah's name a second time. Isaiah's chin stays up longer this time, but his breathing increases, and his eyes start to look a bit drowsy. By the third time Dad calls his son's name, Isaiah seems to be fast asleep.

Before Isaiah was born, Steve had seen a movie about how babies can see and hear right from the start. "Why won't he look at me? Something must be wrong with Isaiah's eyes!" Steve says.

Isaiah has just demonstrated a rather remarkable newborn behavior. He is giving Dad all the attention he can afford right now. His rising chin indicates his efforts to engage with Dad, but because he is so young and still maturing in his abilities, he can't take on looking right at his dad's face. When Dad continues to call out to him, Isaiah sends out an SOS (Sign of Over-Stimulation) by increasing his breathing, then drifting off to sleep. (See http://www.hugyourbaby.com/skills.html)

When Steve and I discuss this normal newborn behavior, Steve seems excited. "I see, he's tilting that chin up like he's trying to talk to me." Steve could now appreciate his son's great efforts to engage with his Dad.

At Isiah's one-month-old check up Steve shares how Isiah had become able to look him right in the face over the last two weeks. "I just watched that chin come up, then I'd get real quiet a minute, and finally his eyes met mine. It was love at first sight!" Steve declared.

"For Cryin' Out Loud!"

Tonya remembers the images she had of what it would be like to be a mom: the glow of a soft nightlight, the smell of baby lotion, the feel of a warm cuddle, and the sound of gentle cooing. She did not imagine the glare of bright lights as she searches for the "butt cream," the smell of the diaper pail she was too tired to empty, the feeling of full breasts, or the endless (or so it seems!) crying of her baby.

All babies cry, and maybe you've discovered that most new mommies cry as well! Crying is communication. Newborns begin to increase their amount of crying at around two weeks of age, and the time they spend crying peaks by six weeks. Colic is defined as crying for more than three hours a day, for at least three days a week, for at least three weeks. That's a lot of tears! Though the cause of colic is still not understood, recent research shows that smoking during pregnancy increases the risk of colic. (http://www.erikson.edu/media.asp?file=releasefussy)

Jamal is an intense, robust young fellow. When he cries, he is serious about it! He flails around and won't put up with swaddling. After being fed and changed, he is calmed only by a vigourous sway. He likes the swing, and he's fond of a car ride, a stroll around the block, or dancing with Dad. It takes a lot of stimulation to keep him calm.

On the other hand, Reggie seems especially sensitive to the world around him. A loud sound or even the movement of a diaper change rattles him. He needs to suck his paci and close his eyes (as if to shut out the whole world!) before he can calm down. His parents discover that swaddling and holding his hands against his chest help him. Being carried in a baby sling or cuddling on the couch with Mom helps too.

Parents struggle to learn what works best for their baby. Research (by Bell and Ainsworth) shows that when mothers give an early and more nurturing response to their crying babies during the first year of their lives, those babies criy less the second year of their life. Their mother's prompt response seems to increase attachment and to enhance the child's sense of security.

Though crying is a challenge for all parents, for some it triggers a frightening reaction. Mothers experiencing post-partum depression, parents lacking good social support, and all families struggling with substance abuse issues are at risk for letting their feelings fly out of control. These parents need special help.

Ask for help: a neighbor to stroll the baby while you take a quick nap, a huband or friend to take the baby to the store for some diapers while you soak in the tub, a grandma to show you what trick worked best when you were a baby. (See http://www.hugyourbaby.com/calming.html) Soon you will be able to tell his tired, from his mad, from his hungry cry-- and know what works best for your baby, and for you.

© HUG Your Baby 2012