Things NICU Nurses Wish You Knew!
Welcome to part 2 of 3 of our series on labor & delivery, today’s topic NICU, and postpartum next week! Today’s topic will be one that may or may not have a role is your delivery and postpartum stages, but definitely has some points worth mentioning. One of the many nurse friends I have, works in the NICU, or Neonatal Intensive Care Unit, a special ICU just for babies. Over the years I’ve heard snippets of stories where babies have overcome so many obstacles and are living very normal lives today. The NICU can be a very scary thought when you imagine your delivery day, as it’s plagued with rumors of dangerously ill children, and even those that may not make it home. And though, there are unfortunately those newborns there too, there are many times where a visit to the NICU may be a hospital policy, or even a quick trip just for additional safety measurements, and shouldn’t be something you are afraid of, if you’re aware of the circumstances, of course.
Every book, article, and not so accredited blog post you’ve read is going to go over “normal” deliveries and postpartum care, but what happens when something may be, ever so slightly, abnormal? To help you navigate through these uncharted waters, my friends and I have sat down for hours, pouring over what is is a true “normal” that families are not actually being educated about. Let me first tell you, your birth will be unlike anyone else's. It is your story to write, and your beginning to a new balancing act. The first thing to plan for, is for things to not go according to plan. There are simply too many variables for you to have an iron-clad agreement with your spouse, healthcare providers, or any of the gods in the universe. You cannot control what will happen, but you can be aware that everything that happens is with the exact same goal in mind: your and your new baby’s safety.
Let’s get going!
Please note, names with an asterisk (*) have been changed in this dialogue to protect identities. The following statements are in no way endorsed by your specific doctor or follow your specific health needs. Always consult your doctor or healthcare professional prior to starting, stopping, or continuing any advice outlined in the following post. Take what you can, and be sure to ask questions to your healthcare provider.
Part 2: The NICU (Neonatal Intensive Care Unit)
*Jasmine has been working as a NICU nurse for over 4 years at a highly rated, level II NICU in California. Their 31-bed MICU is able to care for newborn children who are born before 35 weeks of gestational age, those who meet a minimum weight requirement (2000 grams or less), and/or those children born with critical illness or complications. Jasmine* has held babies that fit into diapers smaller than a Post-It note. She’s comforted hundreds of babies over her years of experience in the NICU, assisted on cesarean deliveries, and happily watched as families get to finally take their newborn baby home after a stretch in her department. Jasmine* is a mother of her own baby who had to spend a bit of time in the NICU, and as a mother with this experience, she is able to offer some amazing tips on the NICU from a nurse’s and family’s perspective. This is her list of items she wants you to know!
The Top 4 Reasons Babies End Up In The NICU:
Jaundice - You’ve probably heard of jaundice if you’re a fan of House M.D. or Grey’s Anatomy by a cast member gazing into the eyes of a patient and noticing the yellowing of the whites of the eyes, and then announcing ominously to the room, “your eyes are yellow, your liver is failing!”. First things first, babies are born with immature livers and cannot always break down red blood cells. When the red blood cells begin to break down, they will release a yellow pigment, called bilirubin. If the liver is not mature enough to pass and process the bilirubin, it can cause a yellow tint to the skin and eyes.
Treatment: Baby will need to eat. Peeing and pooping helps get rid of build up of red blood cells. If baby is not taking in enough food, for whatever reason, they may need IV fluids to help flush out cells. Baby can also get put on Bili-lights, phototherapy blue lights to help break down red blood cells. It’s important to leave baby on the lights as much as possible except when feeding. Remember that sleep, the exposure to lights, and feeding will get them out of the NICU sooner!
Blood levels will get checked daily until numbers stabilize and baby can go home!
What to look for: Jaundice can make baby lethargic, they can also become poor feeders. You should have a checkup within 2-3 days of discharge from the hospital, but should you notice anything irregular be sure to contact your pediatrician.
Infection - The largest reason babies detour to the NICU to check for infection, is if mom’s waters have been ruptured for a long time (over 18 hours). If baby is assessed to be acting abnormally, labs may be drawn and ran (specifically blood cultures), and in the meantime baby will be sent to the NICU for antibiotics and IV fluids.
Treatment: Baby’s blood will be drawn and the culture will be the true indication of an infection. This takes 48 hours for cultures to come back, and often times, baby will be started on antibiotics before results come back (as opposed to waiting 2 days and the infection spreading or worsening).
What to look for: irregular temperatures, excessive tiredness, difficulty breathing, etc. will be monitored by a nurse. Always ask questions or bring anything abnormal to the attention of your nurse!
Respiratory distress - Presentation of respiratory distress, or difficulty breathing, is common among babies that are born quickly, or those born via C-sections. When baby is born vaginally, at a normal rate, the squeezing sensation through the birthing canal will help get fluids out of the baby’s lungs. Respiratory distress is also common if baby takes their first gasp of air and breathes fluid into lungs.
Treatment: Babies with respiratory distress that require NICU assistance will get an appropriate method of oxygen delivery depending on the severity of the distress. They will be on the breathing assistance tools until the fluid in the lungs is absorbed and they are breathing easier on their own.
What to look for: Respiratory distress is categorized as difficulty breathing, (grunting noises), nasal flaring, breathing very fast, or other, more complex issues that your NICU nurse will be able to assess. Some deliveries will have respiratory distress in the newborn initially, but baby can transition out of it, others will end up in the NICU if they need a little more help and attention.
Low Blood Sugar - This one depends on your hospital’s policy. There are many factors can play into a baby having low blood sugar, but typically the larger than average and smaller than average babies have a predisposition to low blood sugar.
Treatment: Mother’s milk is usually sufficient in balancing blood sugar, but if it is not, it is okay to supplement until your milk comes in. Not to be confused with colostrum, actual milk comes in 3-5 days after birth. A lactation specialist may need to help you express the colostrum (any way possible) to get the food to the baby. If all else fails, and blood sugar remains low, baby may have to go to NICU to get supplemental IV fluids to stabilize the low blood sugar.
Side Note For Preterm Deliveries: If baby is born 35 weeks or sooner, it will likely go in the NICU for prematurity (usually hospital policy).
Dos & Don’ts For The NICU:
If your baby is in the NICU, this is a fragile time in their lives regardless of the severity of the issue and visitors may not be a good idea. Though it is a joyful moment for family, most nurses prefer for mom and dad to be the only visitors while baby is getting treatment. Visitors are of course welcome, but baby’s health must be a top priority. Bonding, eating, and sleeping must be the highest importance, and if family is coming to wake baby up, or interrupt procedures, this can add to the time your baby may need to stay in the NICU. If someone comes in, let them know to leave baby be and not to interrupt sleep. How would you feel if someone woke you up at 3 AM while you were sick and sleeping?
Don’t allow anyone is who is or has recently been sick in the NICU to visit. Seems obvious, but this is for the safety of your newborn baby, who already has a compromised immune system prone to disease.
Whether you’ve been sick or not, WASH YOUR HANDS. Before and after touching baby, or being in the NICU in general, make sure you are also taking appropriate measures to keep yourself healthy.
Be quiet and courteous to others. The NICU is designed to be a tranquil place for babies to heal and grow. Your baby will not be the only sick, fragile child in the NICU. Be aware of others.
Always ask questions. Never be afraid if you don’t understand something. From procedures and labs, to giving baths, nurses are full of knowledge and always are happy to help!
Ask if you can extend your stay. Some doctors will allow you to stay in the hospital longer if your baby must stay in the NICU, but you may have to ask.
If baby is kept in the NICU and you are discharged, you should make your NICU nurse aware of your feeding preferences.
If you do not want baby to have formula whatsoever, you must understand that you will need to either come to the hospital every 3-4 hours, or give the NICU a stash supply of milk to help feed the baby while you are away.
If you cannot come to the hospital to breastfeed, if you are unable to provide a pumped milk supply (whether your milk has not come in OR you just do not have time to come to the hospital) remember that you have a hungry child that MUST eat to regain their health so they can come home.
Be open to supplementing formula, and know that it is not the end of the world. Formula can be a temporary fix while your baby is healing.
If you’d like to ensure that your milk comes in consistently while baby is in the NICU, pump every 2 hours, or at least 8 times in 24 hours to mimic what you baby would be feeding if they were home.
Remember that breastfeeding demand increases supply. If you are feeding more often, your body will regulate and supply more eventually.
Remember that baby is a patient, but YOU are too. It’s okay to take your prescribed pain medications, drink water, rest when you can, etc. Take care of yourself, because when baby feels better, you will be BUSY!
Communicate with your nurse as much as you need to! You will have a neonatologist who will make rounds in the NICU, but they may only make those rounds once or so daily. You will have better access to your nurse caring for your child directly. The nurse will relay all charting notes and information to the neonatologist who will discharge them from the NICU when baby is feeling better.
Things You Can Do To Avoid The NICU:
Healthy diet. Eat your colors people! Stay away from the hot fudge and empty calories. Your baby needs all the good, quality food for nutrients to grow all different parts of it’s complex little body.
Listen to your doctor. If they say you need to induce, a C-section, or baby needs a visit to the NICU, it’s not the end of the world. You, the nurse, and doctor all have the same goal, a healthy delivery, momma, and baby.
Things Your Nurses LOVE:
FOOD. Donuts, cakes, pizza, sandwiches, etc. They are working hard and get hungry!
More than food, your NICU nurses LOVE to see baby later in life. “What we love even more is updates, photos, or visits when they get older, especially our little guys!” Make your NICU nurse’s day and drop them an update. They’ll feel like a superhero!
And there you have it! Another installment of things your nurses wish you knew. Of course, this article (hopefully) won’t apply to you and your delivery story, but if it does, know that you are in good, caring hands. Your nurses want to see your baby get back into your arms and go home as soon as possible! Share with your momma friends, and make sure you discuss possibilities like complications at delivery or a NICU visit with your spouse or caretaker. It makes everyone’s lives easier if you are ALL prepared for the best and worst case scenarios, though, we hope ONLY for an amazing meeting day when your little one arrives!
If you haven’t read my installment article on Labor & Delivery, please do! See you next week with POSTPARTUM!