Premature babies and special care

Premature baby in incuabtor

Sometimes babies decide to put in an appearance before they're due to – medically, babies born before 37 weeks count as premature. Many twins and triplets are born prematurely, with their average delivery dates 37 weeks and 33 weeks respectively. While it's not uncommon, if your baby does arrive early, he may need some extra care to make sure he's fully fit and ready to face the world outside before you're allowed to take him home from hospital.

Premature birth means a baby needs extra help to keep warm, breathe and eat until his body catches up developmentally and he's ready for the big wide world. Premature babies are more prone to picking up infections so sometimes they are safer in hospital for a while. Other factors which the medical team consider include low birth weight, jaundice, having trouble breathing or with circulation, needing surgery, or being born with special needs – any of these things may mean they require extra care in the early days.

There are several types of care available, depending on how much help your baby needs. He may be put in a neonatal unit (NNU) if he was born just a little too soon, a special care baby unit (SCBU – pronounced ‘skaboo’) if he needs a bit more care, or, for the most serious cases, a neonatal intensive care unit (NICU). But whichever it is, you’ll know that it is the right place for your baby at the moment and he’ll be getting the very best care available.

What happens in a special care unit?

Special care units are there to look after your baby until he is big enough, or well enough, to come home with you. Special care can sometimes be provided on a postnatal ward but if your baby needs extra help he may go to a neonatal unit.

If your hospital doesn’t have one (or there are no cots available when you need them) he may be transferred to another hospital where he can receive the care he needs.

Units will have lots of ‘cots’ and incubators with the babies in. They may just need to be kept warm and monitored for a few days, or they may need to be helped with feeding and breathing.

What are all the machines for in the special care unit?

The unfamiliar beeping machines, wires and tubes can look daunting but as soon as you know what job they’re all doing you’ll feel less put off by them – do ask the doctors or nurses about anything you’re not sure of but here are a few of the bits of equipment you might see:

  • Incubator – this is used to keep your baby’s body temperature at the right level. Premature babies get cold very easily as they haven’t yet laid down enough fat on their bodies. Incubators can sometimes control moisture levels as well as temperature.
  • Ventilator – pushes air in and out of the baby’s lungs if he is having trouble breathing by himself. You might also see a CPAP machine (continuous positive airway pressure), which inflates lungs and then keeps them open, while the air goes in through a mask or tube.
  • Tubes – used for giving your baby food, fluids or medicines. They usually go in through the nose or mouth, but sometimes directly into a vein.
  • Monitors – these are the machines that you’ll see flashing and hear bleeping (a lot). After a while you’ll get used to it and won’t feel your heart fall through the floor every time an alarm goes off. They can be monitoring anything including temperature, oxygen levels, heart rate and blood pressure.
  • Lights – your baby may be given phototherapy if she is jaundiced. Jaundice occurs when the body can’t dispose of bilirubin as quickly as it’s being produced. Light therapy can help with this.

How long will my baby stay in the special care unit?

The length of stay will depend on how prematurely he was born and whether he has any additional health problems. Special care units provide expert care to help your baby grow and develop, as well as offering treatment for any health issues that may have caused the premature birth, or resulted from it.

Medical staff will be concentrating on helping your baby to breathe, as his or her lungs aren't yet fully developed. Babies born before 35 weeks may not make enough surfactant – a sort of fatty substance that allows their tiny airways to open and close – and they may be given steroids to encourage their body to make more and help lungs strengthen and develop quickly.

They'll also be checking that he's maintaining a good body temperature and getting enough food until he is able to do all these things for himself.

I found it helpful to keep looking to the next milestone – a certain weight gain, coming out of the incubator, first try at feeding, that sort of thing, as that gave us a series of achievements to celebrate which helped me feel more positive.

For you, and your partner, rather than adjusting to life with a new baby in the comfort and security of your own home, life revolves around the care unit, which can feel quite worrying, understandably.

In addition to the usual hormonal upheaval and tiredness most women experience after giving birth, you may well have anxieties about your baby's health and future. Plus, if you have other children, you might feel worried about not being there with them – as well as the logistical headaches around childcare.

Every day is a bit of a battle, or as one mum says: “'rollercoaster' is the word.” But there’s lots you can do to care for your baby and look after yourself in these worrying early weeks – just take it one day at a time.

Your baby is in the very best place, so accept any help and support on offer – whether that be from friends and family, medical professionals and even fellow mums of prem babies on the Mumsnet Talk boards.

Remember that this is not for ever and that lots of other families have gone through the same thing and come out the other side with babies who are now healthy, happy, hulking teenagers.

Who will look after my baby in the special care unit?

There will be a whole team of experts you’ll quickly become acquainted with, from neonatal nurses to consultant paediatricians to junior doctors, physiotherapists and more. Don’t forget though, that you, as your baby’s parents, are the most important of all his carers.

The staff will be there to answer any questions and let you know what’s happening and why, but you’re a vital part of her care.

Can I stay with my baby in the special care unit?

Many units these days do have space where parents can stay in hospital with their baby but this might depend on what’s available, how long your baby might be in special care for, and how poorly your baby is.

If your baby’s stay is going to be a long one and the hospital doesn’t have the facilities for you to stay, you may have to leave hospital and go home without him. This can obviously feel heartbreaking when you thought you’d be carrying your newborn baby through your front door in his car seat, so go easy on yourself and don’t feel silly if you find this time very upsetting.

You should still be able to visit the special care unit every day. This can be really exhausting, particularly if you’re expressing breastmilk every few hours and perhaps coming home late at night. Don’t forget to make sure you get lots of rest. You’ll need all your energy for when your baby is finally home.

Will I be able to touch my premature baby in an incubator?

Mum and baby hands

Some incubators have no ‘tops’ on them so you can reach in and touch your baby or let her hold your finger (aw!) whenever you like. Others have two holes in the side you can poke your hands through. The midwives will show you how to use these – you might even be able to do things like change your baby’s nappy in the incubator.

Some hospitals are now pioneering schemes where parents learn to do basic medical tasks such as putting in feeding tubes and taking their baby’s temperature when in special care. This sounds scary but has actually been shown to help parents feel more in control and shorten the length of babies’ stays in hospital.

Can I breastfeed my premature baby?

Yes, but first discuss your desire to breastfeed your baby in the special care unit with her medical team and ask to speak to the unit’s lactation consultant. If possible, chat with other mothers on the unit about their experiences of breastfeeding a premature baby. If you had twins (which are often born early), ask the nurses for any special advice on breastfeeding twins too.

If your baby was born before 34 weeks, she might be unable to suck, but you can still express your milk so that it can be fed via syringe or to your baby’s stomach via tube. It’s understandable that you might feel sad about doing this, instead of having your baby suckle as you’d envisioned, but keep in mind the health benefits of breastmilk and remember that this is only temporary.

The NHS Choices website recommends you express eight to 10 times a day, including at least once at night, in short sessions, to keep your milk supply up. It’s better to do this by hand, at least initially, and your midwife or breastfeeding supporter can show you how.

Can I formula feed my premature baby?

Yes, and there’s no reason why premature babies can’t thrive from formula feeding. Ask the NICU staff to recommend the best formula option for your baby.

If you’re formula feeding because you were unable to breastfeed then don’t worry. You can still enjoy the intimacy of feeding through kangaroo care, cuddles and plenty of eye contact.

That said, you might not be able to feed your baby from a bottle straight away. The milk might need to be fed into your baby’s stomach via a tube. But the medical team can show you how to take charge of this, so that you are the one responsible for making sure your baby gets the nourishment she needs.

How can I bond with my premature baby in the special care unit?

Bonding with your baby may take longer if your baby is in an incubator, but equally it may not. There's no 'right' way to feel, so don't beat yourself up. You're in uncharted emotional territory and you may be feeling pretty shocked.

Plenty of mothers admit to not feeling a rush of love, and finding bonding hard. They describe feelings of grief for their 'lost' pregnancy, or anger that they have been robbed of those last few weeks of blissful whalehood. These feelings are completely normal so don't feel guilty if you feel this way.

Don't ever be afraid to ask a question or ask to hold your baby or anything else.

It’s important, though, to bond with your baby and doing so could help you get through this difficult period. Don’t get disillusioned if you make slow progress. After all, your baby is supposed to still be in the womb, so it might be a few weeks before she’s able to show interest in the world.

Here are some things you can do to connect with your baby in the special care unit:

  • Kangaroo care: strapping your baby to your chest, so there's skin-to-skin contact. In the welter of medical equipment, it's a way of bonding with your baby and nurturing them.
  • Imitate your baby – when she looks at you, try to sustain eye contact and see which sounds and facial expressions hold your baby’s interest. This encourages her to be calm and alert.
  • Talk to your baby in a calm and soothing voice. Help her get used to your voice, just as you would if you were at home, as she will grow to find your voice reassuring and it will help her to stay calm.
  • Read stories. Studies show that parents who read stories to their children in the special care unit continue the habit when they get home. That can only be a good thing.
  • Feeding, nappy changing or washing your baby are tasks you will be able to do as he or she grows stronger. Ask the staff, and keep asking, which jobs you can safely perform for your baby.
The neonatal ward is really daunting at first but you will get used to it. Talk to the nurses, ask questions but remember that this is YOUR baby and you are entitled to be there as much as you want.
  • Protect her from overstimulation. The staff are conscientious but the environment in the special care unit can be over-stimulating for your baby. If you sense that she’s sensitive to light then ask for the lights to be dimmed and for the monitors to be turned down.
  • Place something impregnated with your smell next to your baby to comfort them. Some people recommend putting a soft toy down your top, or sleeping with a soft blanket, then leaving it with your baby when you're not there.
  • Make a home away from home. It’s impossible to predict how long your baby will be in the special care unit, so try to make it as hospitable as possible (although you might have to check with staff that this is allowed), especially if you're staying in hospital too. You could put up family photographs and any other decorations/mementos that will help you both feel at home.
Mum carries premature baby

What can I do in the special care unit to help myself and the rest of my family?

It is a shock to the system to find yourself separated from your baby and dependent on hospital staff for his care. It's natural to feel helpless, surrounded by people who seem to know better than you what is best for your baby. “I feel like I'm playing at being mum and they are the real carers,” says one Mumsnetter. “It is such a confusing time.”

You have been through a difficult time, physically and emotionally. You probably aren't feeling yourself and some of your emotions might surprise you. “I felt I hadn't done a good enough job of keeping my baby in my tummy,” writes one mum of a premature baby. “I felt it was my first job as a mum, and I'd failed.”

But don't be hard on yourself. You might not know what's best for your baby right now but he will always need his mother. Here are some practical steps you can take that will benefit everybody:

Look after yourself

  • Take regular showers or baths, if you're staying with your baby, and have regular changes of clothes to help you feel more human.
  • Baby units are very hot usually, so make sure you drink enough and don't get dehydrated, and have lip salve and moisturiser with you.
  • You might not want to leave your baby’s side for a second but taking breaks, and making time for other members of your family, is good for you. Keep active and get outside too, as that will help keep your strength up.

A notebook was really useful – I kept a diary of how things were going, positive comments from the doctors, how much milk they were having, when they opened their eyes etc and it was so useful on the bad days to look back and see how far they had come.

Ask questions

  • Get to know your baby’s doctors. The pace of the unit can be hard to keep up with but don’t be afraid to ask the doctors questions. If you don’t understand their answers then ask them to explain in layman's terms, draw diagrams, or whatever it takes to keep you up to date with your baby’s progress.
  • Savour good news. Don’t get carried away but, when your baby makes progress, take heart from knowing that things are improving. Likewise, don’t despair when there are setbacks.

Accept help

  • Accept help. If people offer to help you then say yes and tell them what would be useful. This could range from practical to emotional support but, if the help is available, use it.
  • If you have other children, family pets etc, you will need to get extended family and friends to muck in and help with pick-ups, care, homework, meals, dog walking and generally keeping the domestic wheels turning.

Keep in touch

  • Take photographs. These can be surprisingly meaningful for you and your family at this time, especially if you have other children at home. It will help your relatives and friends, who can’t visit you and your baby at the NICU, and give you a stronger sense of the support network who are rooting for you both.
  • Delegate – you don't want to have to spend time you get away from the baby unit on the phone or laptop updating everyone. Think about sending a group email, or having one person update those you want to keep in touch with, so you only have to say everything once.

Express your feelings

  • Let your emotions out. There’s no point hiding the strong feelings you are bound to be experiencing. If you want to have a good cry then don’t hold back. The release can be good for you.
  • Keeping a journal can help in a similar way. Putting your feelings down on paper can be cathartic and, having the journal to look back on when this difficult period is over, will show you how far you and your baby have come.

And appreciate other people's feelings

  • Understand that your partner might react differently. Your partner is your greatest source of support but, under enormous pressure, you might still become frustrated with each other. Keep communicating and remember that you both want the same thing – the health of your baby.
  • Your other children may be jealous of the amount of your time their new sibling is taking up. It's difficult because you can't be in two places at once, but try to normalise the situation as much as you can, talk to your children about their new baby brother or sister, get them to do pictures for him/her and, when possible, try to get a bit of time alone with them.
  • The hospital might be able to help your children understand the situation, by explaining to them why the baby needs to be in the NICU, giving them a tour of the unit and just generally involving them in the process.

Seek out support

  • Find someone to talk to if the stress is getting too much. Bliss, the special-care baby charity, has been a lifeline to many Mumsnetters. A social worker at the hospital should be there to help with practical problems, and most hospitals have trained chaplaincy teams who can provide a listening ear for any patients or carers in the hospital.
  • Talking to other parents who have been through, or are going through, a similar experience, either on Mumsnet Talk or at the hospital, can also be an incredible support.

Taking your premature baby home

Bringing your baby home will be an exciting milestone – but also your next challenge. Ask if you can spend a couple of nights at the hospital before your baby is discharged. Don't expect to get a good night's sleep, but it will help build up your confidence for night-time parenting. If you have any questions at all, ask the staff.

Going home can feel really strange when you’ve been used to the support and routine of the SCBU, but remember that the doctors will only let you go home once they are positive you’re both ready.

Once you get home, you may feel slightly terrified that you have to care for your baby without the back-up of healthcare professionals. The responsibility can feel overwhelming. But you've come this far and you will adjust and gain in confidence.

It was the only thing we could control at the time, so we only allowed parents, grandparents and our sisters to visit him

Some parents can't wait to show off their baby, others prefer not to have anyone else involved at this stage. For now, it's you and your baby who count – everyone else can wait, if necessary. Carrying your baby around in a wrap sling can help you to bond once you're home.

The majority of babies who need special care will go on to be just as healthy, adorable – and demanding – as their peers. It may not be the start to parenthood you had imagined, but it is a start nonetheless, and hopefully you've had your share of the bumpier patches of your parenting journey. Good luck.