Monday, August 20, 2012

Premature Rupture of Membranes (PROM) and Preterm Premature Rupture of Membranes (pPROM)
Premature rupture of membranes (PROM) refers to a woman who is beyond 37 weeks' gestation and has presented with rupture of membranes prior to the onset of labor. Rupture of membranes is more commonly referred to as “water broke” or “broken sac”.  Preterm premature rupture of membranes pPPROM) is a repture of membranes prior to 37 weeks' gestation. pPROM is associated with 30-40% of preterm deliveries and is the leading identifiable cause of preterm delivery.  pPROM complicates 3% of all pregnancies and occurs in approximately 150,000 pregnancies yearly in the United States.[1]


[2]
Causes
At term, programmed cell death and activation of catabolic enzymes, such as collagenase and mechanical forces, result in ruptured membranes.  Essentially, it’s the normal “water broke” process that pregnant women experience, but often prior to contractions / labor.   
pPROM is a bit more difficult to pinpoint causes, however it is likely due to the same mechanisms and premature activation of these pathways. However, pPROM appears to be linked to underlying pathologic processes as well, most likely due to inflammation and/or infection of the membranes. Clinical factors associated with pPROM include low socioeconomic status, low body mass index, tobacco use, preterm labor history, urinary tract infection, vaginal bleeding at any time in pregnancy, cerclage, and amniocentesis. [3]
I was laying in bed while I was 25 weeks pregnant with boy/girl twins, watching the evening news, when I felt wet “down there”.  I literally started giggling as I thought to myself, “I’m only 25 weeks pregnant and I’m already peeing my pants!”  I got out of bed, took my yoga pants off, and noticed it was a little more than the dribble I felt.  I walked to the bathroom where I sat on the toilet, stood up, and a huge WOOSH of water came out.  I knew right then and there that it wasn’t urine, it was fluid, and that my water had broke.  I called my OB and she told me to put a pad on and get to the hospital.  I told them that at this point we were beyond a pad, hung up the phone, stuck a towel between my legs, and headed to the hospital where they confirmed almost immediately via an AmnioSense strip test that it was amniotic fluid.  Looking back, I believe bleeding from a subchorionic hemorrhage or hematoma present with Baby A from weeks 9 until 17 deteriorated her sac and caused my pPROM.
Treatment and Risks
Unfortunately, there is no treatment for PROM or pPROM.  With PROM doctors feel that, in the majority of cases, it is safer for both the mother and baby to induce labor and deliver early.  However, some doctors may choose to put a mother on hospital bedrest and a non-stress test (NST) given daily to monitor the baby and ensure there is no distress.  Antibiotics are likely to be administered to ward off infection.  There remain different schools of thought, but PROM mothers are likely to face immediate delivery.
The course of action for pPROM is significantly different.  Mothers are put on strict hospital bed rest with constant monitoring unless there are other significant risks to the mother and / or baby to consider including fetal distress.  In those cases, immediate delivery is suggested.  The hope is to stop / prevent labor and stave off infection for as long as possible with the goal to keep the baby in for as long as possible until it is safer outside than inside.  Since amniotic fluid is essentially baby urine, a baby can last quite some time in a broken sac as long as infection stays away. 
Magnesium sulfate is often given to stop labor and corticosteroid shots (ex. betamethasone) to help accelerate the development of the baby’s lungs.  Magnesium sulfate is also linked to protecting the sensitive tissues of the brain in premature babies and can lessen the risk of cerebral palsy.  An antibiotic regimen is also started to work against any potential infection and NSTs are conducted at least daily.  Additional monitoring such as ultrasounds to identify size and monitor fluid levels may be prescribed as well.
An ultrasound was conducted that showed Baby A, baby girl Keltie, had a broken sac and low amniotic fluid.  Baby B, baby boy Colton, had a sac still intact and both babies were not in distress.  While in the admitting room, they also found I was contracting every 3-4 minutes and I was immediately given a steroid shot (the first in a series of two) and started on magnesium sulfate to stop the labor.  I was put on strict bed rest where I couldn’t get up to use the bathroom or shower.  But, I was willing to do anything to keep the babies inside for as long as possible.  I had three goals given to me:  1 – make it 24 hours for the second steroid shot, 2 – make it another 24 hours past that to have the steroid series considered “complete”, and 3 – make it to 26 weeks gestation where the survivability rate goes from 50% to 75% for the babies.
The vast majority of women proceed to go into active labor and deliver soon after pPROM. With appropriate therapy and conservative management, approximately 50% of all remaining pregnancies deliver within one week after pPROM. Thus, very few women remain pregnant more than 3-4 weeks after pPROM.  Spontaneous sealing of the membranes does occur occasionally (< 10% of all cases), mostly after pPROM that has occurred subsequent to amniocentesis; however, this is the exception rather than the rule. [4]  Women suffering pPROM should ensure they are at a hospital with a Level III NICU capable of dealing with babies less than 34 weeks gestation.  If not, a transfer request should be made to one able to handle complicated premature babies.
I made it 4 days before Keltie stuck her feet through my cervix and sent me into full blown labor.  I was rushed in for an emergency c-section and on January 24, 2012 at 3:19am at only 26 weeks and 1 day gestation, I gave birth to two beautiful twins.  Colton weighed 1lb, 13oz and Keltie weighed 1lb, 9oz and both were 13 inches long.  After 100 days in the NICU, Keltie joined us at home.  Six weeks later and after 142 days in the NICU, her brother Colton finally joined us – that was the happy ending we were waiting for.  Today they are growing and thriving – to learn more about our story, please visit:  Project26WeekPreemies.


[1] http://emedicine.medscape.com/article/261137-overview#a1
[2] http://www.tommys.org/page.aspx?pid=972
[3] http://emedicine.medscape.com/article/261137-overview#a1
[4] http://emedicine.medscape.com/article/261137-overview#a1

Anemia is a common problem among premature babies in the NICU. Preemies are immature, so the systems their bodies use to make red blood cells are also immature. Even term babies have a normal period of anemia around 2 months of age, so you can imagine how anemic a preemie can get!

Most newborn babies have at least mild anemia. Infants' red blood cells break down faster than new red blood cells are made. Babies are usually at their most anemic around 2 to 3 months old, and gradually improve over the next two years. This normal anemia usually doesn't need any treatment other than a healthy diet with plenty of iron.

Because they are born early, preemies may develop more a more severe type of anemia called anemia of prematurity. In the last weeks of pregnancy, two changes occur that help full term babies to make red blood cells. First, a lot of the iron needed to make new red blood cells is transferred from the mother to baby in the third trimester. Also, in the last weeks of pregnancy, red blood cell production switches from the liver to the bone marrow. Because the processes that make new red blood cells are immature in preemies, preemies have a higher rate of anemia and their anemia is more severe than in term babies.

NICU care can make anemia in preterm infants worse. Doctors and nurses try to limit the amount of blood that's drawn for lab tests, but even small blood losses can affect very small preemies.
Anemia can only be diagnosed through a blood test. At our hospital, they took a few drop of blood from the foot. If your baby shows symptoms of anemia, doctors may do a blood test to count red blood cells (hemogloblin level) or to look at the percentage of red blood cells in the blood (hematocrit). These tests are often combined into one blood test, called an "H and H" for hemoglobin level and hematocrit.

Our 31 weeker (born at 2lb 3oz) had anemia. Thankfully, it didn’t require any blood transfusions (those are reserved for the severe cases of anemia), but upon discharge, we were instructed to give 1ml of Poly-vi-sol with iron each day (you can get this over the counter). At her one year appointment, her anemia blood test came back clean, and we were able to stop the Poly-vi-sol with iron.

The medicine tastes pretty bad (and smells worse). Therefore, I recommend mixing it with a bit of formula or breastmilk to mask the taste. You may also find that constipation is a side effect or the iron.
Wednesday, August 8, 2012
Group B Streptococcal

Group B Streptococcal, other wise known as Group B Strep or GBS, is a bacteria carried by 30 percent of adults in their intestines and 25 percent of women vaginally.  GBS can cause life threatening infections such as sepsis (blood disease), Meningitis (infection of fluid and lining around the brain) and also pneumonia in a newborn or premature baby.  Babies typically get GBS after it is passed from their mother, to them during birth. 

Diagnosing GBS:
  • Every woman is tested for GBS during her pregnancy between weeks 35 and 37.  It is a simple test that just requires a sterile swab (Q Tip) to collect a sample from a woman's vagina and rectum. 
  • If a woman goes into labor before 35 weeks, then her doctor can still perform the swab test when she comes into the hospital. 
  • 25% of pregnant women carry Group B Strep and are considered GBS positive or Group B Strep positive. 
  • Women who test positive for GBS usually show no signs of the bacteria infection, however they are at risk for passing the bacteria on to their baby. 
  • Group B Strep is NOT a sexually transmitted disease
Preventive ways to keep a baby from getting GBS positive:
  • Women who are considered GBS positive will receive antibiotics through an IV during labor.
  • Women who go into labor before week 37 will usually receive antibiotics during labor
  • Women who's water has broke 18hrs or more before delivery will typically receive antibiotics during delivery
  • Women who have fevers during labor will be given antibiotics during delivery.  \
  • Women who have already had a baby with GBS does not need to be tested again, she will automatically be put on antibiotics during delivery.
  • If you are having a scheduled C section and your water has not broke, then you most likely will not need antibiotics. 
  • Women who get antibiotics during labor have a 1 and 4,000 chance of delivering a baby with Group B Strep.  If a Women who is GBS positive does not receive antibiotics during delivery, her baby has a 1and 200 chance of developing Group B Strep positive. 
Signs of GBS Positive in a newborn and premature babies:
  • Difficulty feeding
  • Irritability
  • Hard to wake baby up
  • Difficulty breathing
  • Blue-ish color to skin
  • High/low Temperature
  • low blood pressure
  • high/low heart rate
How it is diagnosed in newborn and premature babies:
  • The only sure way to diagnose Group B Strep in babies is to do a spinal tap to test the spinal fluid for the bacteria. 
Treatment for newborn or premature baby with Group B Strep positive:
  • They are treated with antibiotics through an IV for several days, and sometimes weeks. 

Early onset disease:
  • Early onset disease means that a newborn or premature baby will show signs of having GBS positive within the first week of life, and it is usually within the first day. 
  • For early onset disease Group B Strep usually causes sepsis (infection of the blood), pneumonia and sometimes meningitis. 
Late onset disease:
  • Late onset disease can occur from the first week through three months of life.
  • Late onset disease can have the same infections as early onset disease, however meningitis is more common with late onset disease. 
Long term effects Group B Strep can cause:
  • 25% of babies who have meningitis caused by GBS develop Cerebral Palsy, Hearing problems, Learning problems, and seizures
  • Care for sick babies has drastically improved in the U.S., however 4-6% of babies with group B strep die from their infections.  And premature babies are more likely to die from GBS than full-term babies. 

While researching GBS positive to write this article, I could not find very much information on Group B Strep and premature babies so I will share my daughter Nora's story with you.

Nora was born at 25w5 days.  When I went into labor with Nora I was tested for Group B Strep and I tested positive so they put me on antibiotics during my labor.  I also had a sever infection of my uterus called Chorio, so I had almost every symptom listed above to be put on antibiotics to prevent Nora from getting GBS positive.  I had high fever, UTI, premature labor, infection, and I tested positive for it, so on the antibiotics I went. 

Nora was born with an infection but it was not GBS, it was chorio so she was automatically put on antibiotics at birth for the first 2 weeks of life.  After her birth all we heard about was chorio, so I did not think we had to worry about Group B Strep at all.  3 weeks after Nora was born she came down with another infection, again not GBS.  She was re-intubated and treated with antibiotics for a few days and then we continued on our NICU journey. 

It was not until Nora was 2 months old and 34weeks gestation, that she became extremely sick.  We got a phone call in the middle of the night telling us that Nora had stopped breathing (she was on nasal cannula at .5L and 21% oxygen) and that they were having to constantly stimulate her to breath.  We had been down this road a few weeks earlier when she had gotten the infection, and I never wanted to go down this road again.  My husband and I went up to the hospital, where I held my almost 4lb baby girl and had to pat her back, rub her head and beg her to breath every 2 or 3 minutes.  Nora turned every shade of blue, white and grey and those are colors I never want to see on my child again.  Nora stopped breathing several times in 2 hours and the Neonatologists decided it was time to give her poor body a break and put her back on the ventilator,  run some blood cultures, and put her on antibiotics right away.  They were pretty sure it was an infection, they just had to figure out which one it was.  It was not until about 12hrs later that her blood culture came back showing signs of GBS, so they then did a spinal tap on Nora (her 2nd one in the NICU) and that is when they discovered she had GBS positive. 

I did not know anything about GBS positive and what effects it could have on Nora but I could tell by the reaction of the nurses when they heard her diagnosis that it was not good.  They treated Nora for meningitis, so she was on antibiotics for 21 days and they kept a very close eye on her and anything out of the ordinary that may happen.  Nora decided that after 36hrs she did not want the ventilator anymore and she extubated herself, by pulling her ventilator tube out, and was able to go back to a 1L nasal cannula.  But she was very sick, lethargic, and swollen for several days.  We were told from our Neonatologist that when a baby gets an infection like GBS positive it can set them back for at least 2-4 weeks in their NICU stay because it just takes so long to fully recover from them.  Our Neonatologist also told us it is very rare that they see GBS positive in a baby that is 2 Months old.  He said they usually see GBS positive in the NICU right after birth.  But he said in rare instances they will see late onset disease, where the GBS has been sitting doormat and just resurfaces one day. I will never forget that day but we are so thankful that today, Nora is 6 months old, out of the NICU and doing great! 
If you would like to hear more about Nora's story you can follow her blog at http://purtylittlefowler.blogspot.com/
In researching for this article I used the following websites:

What happens when an infection is suspected?
Often times through out a NICU stay your preemie may acquire an infection of some kind. The types of infections vary as widely as their symptoms as well as the course of action taken. I remember the first few times the NICU notified me of their suspicions I was terrified and was even more nervous when they gave me a run down of what they would do to identify the infection and the appropriate course of action.
Once the medical staff detected any sort of issue or “symptom” they would quickly jump into action. It usually began with a blood draw that would be sent of for a culture, and would sometimes also include a Spinal Tap as well. If they noticed any type of discharge they would swab the air and send that for a culture as well. Sonograms and/or x-rays could be expected to depending on exactly what was suspected, for example: if there was an area of the body that was swollen or if it was a possible repertory infection they may x-ray their chest, etc.
After that the waiting game began… the waiting for test results. Most often a “positive” would come back on any test rather quickly which meant they could then pursue treatment rapidly. Depending on what exactly the medical team believed the infection was, they would start treatment before that because waiting could causes the infection to get worse.
Something that is important to remember is that you know your baby best. If you notice something different, don’t be afraid to speak up.  You are part of your baby’s care team too and early intervention and detection of an infection is the best treatment. 

Here are some common infections for NICU babies: (check back often, we will add more soon!)
Group B Streptococcal 
Menigitis
MRSA
Osteomyelitis
Sepsis
Saturday, August 4, 2012




My pregnancy was going perfect. Had nothing wrong with anything, baby was growing great, I wasn't gaining too much weight. Just had normal aches and pains, nothing more. That all changed on April 30, 2012. I was 34 weeks exactly. I woke up swollen. My feet hurt if you touched them. This had never happened before. The swelling had always gone down overnight and my blood pressure has always been fine. Well, I took my blood pressure. 154/80. WHAT?! I called the doc to see if he wanted to see me earlier than my 11am appointment. They had me come in at 10. My BP at the office was 165/90. There was a little protein in my urine. My nurse, Linda, had me lie on my left side. She came back and my BP had dropped to 120/85. When my OB came in, he checked my cervix and I was slightly dialted and a little effaced. He put me on strict bed rest. Before I left we did an NST and ultrasound, both came back perfect. I had to do a 24 hour urine and was given BP medicine. I was to monitor my BP twice a day and if it got over 160 then I was to go straight to L&D. Our goal was to make it 3 more weeks to 37 weeks. I ended up in the hospital the next night and was observed overnight just to be discharged with a diagnosis of pre-e. I wasn't to move off the couch except to go to the bathroom or to my bed. Just great, I'm going to go crazy. When I went back to my OB's office on Friday of that week, he sent me directly to L&D because my BP wasn't getting better. I was going to be in the hospital until I delivered this baby. I felt perfectly fine but couldn't do anything. It was very frustrating. On May 7th I told my nurse that I thought my mucus plug had come out and they didn't seem concerned. The goal was now to get to 36 weeks which was Sunday May 13th. We can do this I thought. Well, 4am on May 8th rolled around and my LO had a different idea. My water broke. I didn't start feeling labor until around 1pm, 3 hours after they started pitocin. I didn't have to have mag because as soon as my water broke my BP went down. It was strangly good. At 3pm I was dialated to 4 so I got my epidural. By 530pm I was pushing! Mind you, this is my first, they never expected me to move that quick. At 7:17pm Evelyn Marie was born at 4lb 11oz and 18in long. She was perfect. Absolutley nothing wrong. She spent one week in the special care nursery as a feeder/grower. What a blessing she is!



Friday, August 3, 2012



Dear Cora,
            
The story of the day you were born is a hard story for me to write. I wish I could write something that was filled only with joy, expectation, and love. Those things are all part of your story. But your birth wasn’t only a day of joy, it was also one of the scariest days of my life because I was afraid that I would lose you. Even now, 16 months later, its hard for me to admit that.

The night before you were born, our lives seemed so very normal. Looking back, its bizaar to me that there were no warnings. I went to a meeting at church, came home, and tried to sleep. I woke up a few times that night with what I thought were gas pains. I had experienced that before while I was pregnant so I thought it was normal. By the morning when the gas pains had not gone away, I decided to call the midwives just to make sure things were ok. They made me an appointment for 10:30 that morning. I sent your dad to work and called to make sure your Maw Maw knew I was going in. The whole time I kept reassuring everyone, including myself, that it was not big deal, I was just being extra cautious.

I sat in the waiting room for about 20 minutes before I got to see Theodora, one of the midwives. She hooked me up to a monitor and it quickly became clear that I wasn’t have gas pains, I was having real contractions. So she made arrangements for me to be sent across the street to the hospital where they would stop the contractions. I want you to know that at this point, no one had any idea that you would be born a few hours later. I called your dad and asked him to come up to the hospital to wait with me. He called your Maw Maw for me. The walk from the midwives’ office to the hospital takes about 5 minutes. That’s how long it took for me to go from “we will stop the contractions and send you home on bedrest” to “we need to get some consults in here now!” I was checked into a room at St. Lukes and things began to get scary quickly.

I was hooked up to several monitors and given an IV. Nurses, the midwives, and an OB who I had never seen before kept coming in the room to check me and then walking out for a hushed conversation. The OB examined me quickly, moved to where I could see him and said “we are taking this baby now, we cannot wait.” It was immediately like the world had stopped. I just stared at him thinking that he must be wrong. I was only 27 weeks pregnant. I knew you were not ready for the world yet. But ready or not, you were coming. Your dad walked in the room just after that moment, I was so glad to see him. He was so scared but he tried hard to take care of us instead of himself. The nurses gave him some blue scrubs and wheeled me out of the room to prep me for surgery. He called your Maw Maw, who was on her way to Austin for work, to tell her what was happening. She immediately started calling every single person she could think of. She asked them all to pray for you, and sweet girl I know it made a difference. Then your dad signed a stack of papers-maybe the only time in his life your father signed documents without reading them carefully. I learned all of this later.

I was wheeled into an operating room, moved to a surgical table and given an epidural. After the medicine had started working, your dad was brought into the room and the surgery began. I don’t remember much of the surgery. I was just so scared. You did not cry when you were born. The doctors took you quickly and began to work on you. They helped you breathe with a ventilator, gave you IVs for medication, and wrapped you in saran wrap to help keep you warm. At some point in the middle of all this, Dawn, the midwife who was with us, came to tell me that you were a girl. I remember whispering “her name is Cora.” It was really important to me that you had a name right away, that all the doctors and nurses working on you knew your name. Soon they called your dad over to meet you while I lay on the table still.



Your dad came back to tell me that you were beautiful. There were tears in his eyes when he returned and I knew he was scared. He told me again and again how precious you were. The TCH team was ready to move you to the NICU. They stopped on their way out to give me a minute to meet you before taking you away. I remember touching your itty bitty hand. You were the tiniest thing I’ve ever see. And the most beautiful. I already loved you but in that moment I knew I loved you more than anything else in the world. And I was terrified that something would happen to take you away.

The next few hours are pretty blurry for me. Your Papoo, PePaw, Pastor Kerry, and Beth were the first people to get to the hospital. The rest of your grandparents quickly followed. I remember calling your uncles to tell them that you were here, how beautiful you were, and how tiny. Your dad came back to tell me that you were doing well and settled into your new home in bed A8 of the Purple Pod. He took your grandparents to meet you and they all came to tell me how amazing you were.

Later I learned that when you dad took you to the NICU, the nurses asked him if you had a name and he said “I think its Cora, that’s what her mom said.” He was so overwhelmed. But the nurses made you a special name plate for your isolette.

It was after midnight before I was allowed to see you. I fought hard to be with you my sweet girl. It was all I could think about. So as soon as I was able, your dad pushed my wheelchair to your bedside and I was able to really see you for the first time. You were black and blue, covered in tubes and wire, but already so beautiful and so very strong. You had amazed the doctors already. Within hours of your birth, you were able to breathe well enough on your own to have the ventilator removed. I never saw you with that machine breathing for you. By the time I saw you, you had a CPAP hat and mask helping you breathe but you were fighting to do it yourself. I would learn quickly how determined you were. I truly believe your inner strength helped save your life.

Cora, the day you were born was such a scary, emotional day for me. It will always have those memories. But it was also the day I learned that it is possible to love someone more than you love yourself. I learned that watching your baby fight to live can inspire the kind of love that doesn’t have words. I learned that a tiny 2lb 10oz baby can move people around the world to prayer. And I knew that you would bring more joy and more love to our lives than I ever thought possible. On that day I knew that in making me your mom, God had changed my life forever.

I love you more than words can say and I am so proud to be your mommy. 


Thursday, August 2, 2012



When I found out I was pregnant I knew I wanted to breastfeed. The thought of feeding my child any other way never crossed my mind. I even had conversations with a few friends who were also pregnant at the time. They had mentioned their desire to breastfeed as well but also their fear that it just wouldn't work out. That thought never crossed my mind.

While this is a story about my success with breastfeeding a preemie I need to start with sharing a bit of Isaac's birth story with you. My pregnancy was going great. Until the last trimester. Enter high blood pressure, pre-eclampisa and bed rest. Add in a baby that quit growing and you have a 3 pound 4.5 ounce baby born at 35 weeks.

I had a few strikes against me right from the start. First of all, I had to have a c-section. I had no labor at all. The combination of having Isaac early and the c-section confused my body. I mean I was still suppose to be pregnant after all. My body didn't know right away that I had had a baby.

Before Isaac was born they told me if things looked okay we'd be able to try and breastfeed and do skin to skin within the first hour after he was born. Unfortunately he was having problems breathing in his own. So there was no way we could try breastfeeding or do skin to skin. Enter strike two.

Strike three is probably the hardest of them all. Isaac needed a NICU. The hospital we were at didn't have one. So he had to be airlifted to a NICU 1.5 hours away.  I didn't see him for three days.

I started pumping within an hour of Isaac's birth. I continued to pump every 2 hours during the day and every 3-4 hour at night. For the first two days it was all about signaling the body that it was time to produce milk. I didn't get anything from pumping except a few drops every once it awhile. It was very discouraging. At one point I got about half an ounce and I wanted to jump for joy. By the time I was released from the hospital I was probably producing less than an ounce a day. Whatever I managed to get with pumping I would save for Isaac. Pumping was extremely hard to do simply because there was no emotional connection. I was able to hold Isaac once before he was airlifted. Not being able to see my child made things extremely hard. Looking at pictures helped. But it was still hard.

When Isaac and I were reunited it was still to soon for him to try nursing. He was still really little and slept a majority of the time. So I continued to pump. The NICU had a room with a pump so I was able to stay at the hospital as much as possible. We tried to do skin to skin when we could and finally when Isaac was a week old I met with the lactation consultant, LC, for the first time. She helped me with getting him latched and told me what cues and signals that I needed to look for ensure he was sucking and swallowing. I was watching for raised eyebrows and ear wiggles. That's how I knew Isaac was swallowing.

Once we started nursing I wanted to do it all the time but I couldn't. Isaac was still really little and still slept a ton. Nursing was something that really pooped him out. He rarely ever cued that he was hungry so it really was all about going through the motions. Once Isaac was nursing successful with one feeding we increased it to two. We continued to increase the feedings when he did well. It didn't always go well though and it was emotionally draining on those days. Somedays he'd show no interest in nursing at all. Sometimes he'd get latched on but wouldn't do anything but sit there and he wouldn't eat. When he did nurse he's eat for a few minutes and then fall asleep. We kept working at it though and I met with the LC many times. I continued to pump the same amount I was before. Every 2 hours during the day and every 3-4 hours at night. When Isaac nursed I'd pump afterwards. 

I'll be honest. Nursing in the NICU kinda sucks. We were put on schedules of when I had to try nursing. Typically they were always on the hour but they wanted me there 30 minutes before just in case Isaac was wanting to eat before. If they wanted me to try nursing at 8am they wanted me there at 7:30 just in case. He had to be awake to eat and sometimes he'd be sleepy. Sometimes he wouldn't wake up, even when we tried to wake him. After every time he was awake and nursed they'd ask me how it went. They'd ask me if I thought he ate enough and if I thought he needed more. I was a first time mom. I had no idea. There was so much pressure. Most of the time they'd give Isaac more milk through a feeding tube. When we were first trying to teach him to nurse they usually give him a few tube feeds in between our nursing sessions. I really just wanted to feed him on demand. I wanted to feed him when he was showing signs of hunger, but it can't be done that way. Not when you have a tiny baby on your hands.

Isaac was released when we were able to successfully nurse a full day. They took his feeding tube out and we (my husband and I) roomed in with Isaac. He was released the next day. Isaac and I continued struggle at home with latching on and the length of nursing but we weren't bound by schedules so it made things a lot easier. When Isaac came home the LC told me to keep up with the pumping after every feeding and then drop a pumping session every few days. I am not sure why they wanted me to do this but as a first time mom I listened. It created an oversupply issue which made nursing even more challenging. I was almost always engorged which would often cause milk to get everywhere whenever Isaac would try to nurse. I did some research and spoke with the LC who told me to stop pumping and then try block feeding. I had to nurse from one side for several hours while leaving the other side alone. Then after 2-3 feedings I nursed from the other side. It was an extremely painful process. But it was corrected after a few days.  

Isaac is almost five months old and we still need to use the cross cradle hold because he still needs my support with his head. Sometimes we are able to do the cradle hold but not very often.  A majority of the time he is able to get latched on right away with no issues but it took a long time for us to get to that point. His nursing sessions are never very long. Usually only 10-15 minutes. Sometimes a little longer. And he rarely nurses from both sides. At first I was concerned, especially in the NICU because all the classes and books say 15-20 minutes on one side and 10-15 on the other side. But he was always getting enough. I guess the books and classes are wrong sometimes. It was a long process and there were so many times I wanted throw in the towel. It was really hard but I just couldn't allow myself to do that. Now I look back at everything we went through and I am so proud that we managed to beat every obstacle that came before us. 

Don't give up! Just keep working at it! You won't regret it! 
Wednesday, August 1, 2012
If you don’t know your A’s and B’s allow me to briefly explain.

A is for apnea, a temporary cessation of breathing.

B is for bradycardia, when the heart rate slows to 80 or less beats per minute.

Most babies in NICU will experience both of these at some point. They can be very frightening, but luckily most babies grow out of them quickly. A/B’s can become a hurdle for preemies leaving NICU because they’ll need to be episode-free for several days before discharge.

In some circumstances you’ll be given an apnea monitor to take home with you. They’re very loud (and sensitive!) so you’ll know by the lights and beeps what your child is experiencing.

Leaving NICU with a monitor.
While in NICU practice not watching the monitors – focus on your child! It’s harder than it sounds because when you hear the alarm you want to see what is happening. Leave the monitors for the nurses and instead focus on your child. You’ll need to see how they are doing and if stimulation is needed. Give your baby a chance to do it themselves as hard as it is to not step in immediately.

Like all preemie things they will grow out of A/B’s. For some it might be a matter of days but for others it might take a few months.

Your baby will be monitored by a team of apnea doctors who will analyze the information recorded on your monitor. At first your baby will probably have to be attached 24/7 but once their stats improve you’ll only have to keep them on it at night. Do not brush off your doctor’s instructions! It will only delay getting them off the monitor.

If your baby is turning colors, having a significant amount of A/B’s per day, and/or requiring stimulation on many occasions please contact your doctor immediately and/or go to the ER.
Precious and priceless so lovable too, the world’s sweetest littlest miracle is, a baby like you.

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