How to prepare for premature birth

[eurochick]

Do you have any tips for anything I can do in the lead up? I'm really struggling with this.

I'm currently 31 weeks. Most likely to going to have a small for dates baby some time in the 32-34 weeks window, due to placental insufficiency.

I'm devastated. I'm scared for my baby and I'm scared for me (I'm terrified of hospitals and was planning a home birth, so having a c-section is my worst nightmare). I just can't seem to come to terms with it. It doesn't help that I have completely lost faith in my body. The baby was conceived by IVF after a very long time ttc. I saw the end of this pregnancy as the end of that horrible period in my life and now it just means more trauma.

Any words of wisdom? Anything practical I can do to prepare? I'm the type of person for whom focussing on something practical will usually help.

Thanks in advance.

Having had a baby at 30 weeks (who us now a strapping nine month old) as an emergency c-section, there's not much you can practically do to prepare. The hospital will have everything necessary and until you know how big the baby is you can't really get nappies or clothes ready. Ours didn't wear clothes at first, he was just under bubble wrap!

You could maybe ask to visit the NICU/SCBU to have a look around. Read the BLISS website. Research breast pumps (we hired our own from Medela) etc as prem babies are often too young to suck.

Good luck with it all. I know it's scary but NICU/SCBU staff are amazing x

Sorry you are going through this OP. My DD was born at 28 wks and severe IUGR due to severe pre-eclampsia. I had around 5 weeks to prepare for her early arrival and it was terrifying and heartbreaking.

I would second the advice above to read the Bliss website. Also get hold of a copy or two of their family handbook (you can order via the website) - it is an excellent resource. Try and visit the neonatal unit to look around and ask for a meeting with a neonatal doctor. They will tell you what you can expect. Re breast pumps, you'll probably have use of the hospital's while your baby is there, but it doesn't hurt to look into what you might use when home. I used Medela mini electric and it was great (if a little loud!). Re the c-section, big pants and some stretchy clothes will be your friends.

Wishing you the very best of luck.

Ps. My DD is now a happy energetic two year old - unrecognisable from the tiny bird she once was.

My advice, for what it's worth, is to try to focus on the end result. I know that sounds strange when you've been told you're going to deliver early, but if you've had a journey already, you WILL get your baby home with you in a few weeks time. That is the goal, and you WILL get there. The most important thing is that you'll have a baby, you'll be a mum, and whatever you will have had to go through to get to that point, it will all fade into insignificance once you're home.

Practical things it depends what type of person you are as to whether you want a tour of SCBU. My husband went, I didn't. I needed to have a "normal" image of a baby in my head to get through the last few days of my pregnancy and the labour. In my case, whilst I wanted as much information as possible once the babies had been born, knowledge about what would happen etc and what we could expect, if I'd have seen all that beforehand, I would have been quite frightened approaching the labour I think (I should say I was having twins at 27 weeks so much earlier than you).

Pack a bag for a prolonged stay at hospital. Snacks / clothes / books / toiletries / camera to take lots of photos of your baby / notepad and pen (this is my top tip. I wrote quite a detailed diary when I was in hospital, milestones about the babies, their weights, how much milk they were having, what intervention they'd had, any positive comments the medical staff had made. On the days where one of them wasn't doing quite as well, it was so useful to look back and see that they'd actually come quite a long way. Made me feel much more positive and made it easier for me to cope with their stay in SBCU).

Buy lots of microwave meals / fill the freezer for the days when you are home, but perhaps your baby is still in SCBU and you're running back and forward to the hospital. You might also want to contact the hospital about parking permits (you're usually entitled to a pass of some sort at most hospitals to keep parking costs down over a prolonged period) and if you're having a section and won't be able to drive, think about how you're going to get to hospital. Taxis / public transport / lifts etc.

Tell close family & friends what is happening. Tell them now that you'll invite them to hospital / home when you're ready.

Research breast pumps and find out where you can hire one locally. Contact BLISS, you might find there is a support group locally (just having someone to talk about what to expect can be great) and read some of their leaflets.

And have a read through some of the posts here its frightening but my advice would be that SCBU staff are wonderful and your baby will be in good hands.
Good luck

Thank you both. The mw at the hospital also recommended the Bliss website. I will order the handbook.

I will research pumps too.

I'm glad your children are now doing well.

And another post, thank you too. That's a great tip about the notepad.

I've already visited a SCBU - my friend's husband sneaked me in to see her newborn twins when they were in one.

Parking permits won't help, unfortunately. My husband doesn't drive (he was learning with the aim of getting his licence before our due date, but there won't be enough time now) and I've been told that a section will be necessary at this stage, so it'll be mini cabs until I am up to taking public transport.

I've been reading the board a lot in the last few days. The "tell me your story" thread was very helpful to me.

I hope your twins are doing well.

Hi eurochick,

Sorry you are going through this, but it is great that you are already at 31 weeks. Generally, the older your baby is the smoother and shorter the journey through NICU/SCBU. My DS was delivered by c-section at 27weeks due to IUGR caused by placental insufficiency, so quite similar to you , although you are much further into your pregnancy. I only had an overnight hospital stay before he was delivered, but I would agree with all the advice here.

For me, expressing really gave me a focus as it was something important I could do for my son which no one else could do. The hospital my DS was born at was very pro-breastfeeding which helped, but if you want to breastfeed you need to be expressing a lot in the first weeks to build up your supply. Also, it's really hard but try to eat really well and drink lots of water as this will help your supply.

Definitely try keeping a diary and buy lots of chocolate, for energy, and hand cream, because your hands get so dry from repeated washing.

You will find you become very familiar with neonatal terms quickly, but it is a good idea to write down what is said on ward rounds as it can easily get jumbled in your head when you're stressed and tired. Also, it can be useful to decide how you want to update friends and family on your baby's progress. Perhaps you or your husband could send a group email every few days, rather than constantly having to update people. My DF handled that for me and it was so much easier that way.

I really agree with what Mandy said. You can do anything if it means that you will have your baby home with you in the not too distant future. People often say to me that they don't know how I coped, or that they couldn't have done it. Well, anyone could and would do it if they had to. It is very hard, but you will get there and in the grand scheme of your son's life the time in hospital is very short. I feel that my experience has made me a stronger person and I hope you will feel the same way.

Finally, the Bliss website is very good, but I would advise you not to read too much before your baby is born, because it may make you more worried about possible complications. I feel like there was a time when I was reading so much about premature babies and their development and it's not always helpful, as they are all different.

Best of luck and post again if you want more advice. X

P.S. I should also say that my DS is now 15months old (1year corrected today) and is a happy, healthy little boy!

p.s. I should also have said that my twins are 9 now. They were born at 27+6 and came home when they were 35+5 (they were in hospital for 2 months exactly). I had incredible support from the hospitals. You'd never know they were premature (bright, sporty, healthy, lovely, children) and although their early arrival did have an impact to begin with (I was a tad over-protective) their SCBU stay is just a memory now.

I've just thought of one other thing. It probably varies from hospital to hospital but there were doctors rounds every day (where the dr in charge would be brought upto speed with what had happened overnight / in the last 24 hrs) and then a consultant round every week. You may not be able to be at hospital all day every day, or you might have to go to express at various points, but I was always there for the doctors rounds. As New says, you quickly pick up the terminology (and you can make notes) but it gave me a feeling of being in control as there is a tendency for it to all feel out of your control / out of your depth / like its not your baby. Listening to the medical team (and sometimes making a comment) made me feel involved.

Wishing you all the best xx

That's very helpful, thank you. It is so reassuring to me that your (very) little ones when born are now all doing so well.

Congratulations eurochick.

I had DS at 27 weeks due to placental insufficiency. He was small for dates and I had a CS instead of the birth centre water birth I planned. The birth was really ok. They looked after me very well and I was really confident it was the best thing for him. I recovered well.

At 32+ weeks baby is likely to do very well unless he/she is very small for dates. As others have said breast milk is even more valuable for small and premature babies, and expressing is where you will likely start. Hand expressing is best in the first few days as colostrum is thick. comes in tiny amounts and gets lost in the pump. Best Beginnings DVD is really good and shows hand expressing, worth a watch if your hospital has it. It's divided into sections so you can choose the bits relevant to you. Don't be afraid to ask for bf support in hospital to help with expressing.

Skin to skin with your baby is good for both of you. Don't be afraid to ask for it and push for it if necessary. You are the parent, do/ask for what you think is best.

Your feelings about your body are so normal. I felt that way and I have never met a prem mum who didn't. DS is nearly five and doing well. I still think about his beginnings of course but I feel far away from it, and DS is certainly not defined by it.

I wish you all the best, will be thinking of you.

Sorry you are having such a worrying time.
I had ds at 33 weeks. A few years later when pregnant with dd I started to go into labour at 26 weeks. I was put on bed rest and told to get ready. Scary times.
I made it to 33 weeks again.
Pack, rest. Sounds daft but enjoy being pregnant. Take pics of your bump.
The bliss support line is great. Each baby is different. Mine were born at the same time, but ds struggled (fine now) with weight and was delayed for a couple of years. Dd caught up rapidly and at 8 months is ahead with milestones.
Do you have much family support?

Thank you for your comments. It is great to hear of your children doing so well. I definitely want skin to skin and to bf, if possible (likely expressing in the early days - my mw has already been showing me how to hand express).

I know I will miss being pregnant. I'm enjoying feeling the baby wriggling around in there. It just makes me sad too as he/she should be cosy in there for a good while yet. It took us 3 years and 4 rounds of IVF to achieve this pregnancy. I can't see us ever doing it again, so I feel very cheated to have it end so early.

Second the hand cream!
And for me getting a nuk bottle was great - the soft teets are the same as the ones they use in the NICU so if you do have to feed him/her by bottle for any reason,when you get home they'll be used to this teat, a lot of the more common bottles such as avent are way too hard for them when they're really little.

Hope it all goes well.

If you have a Kindle or e-reader and like to read download lots now. Ds was early and atruggled to maintain temperature so was on a heat mat. I wasn't 'allowed' to hold him much so spent whole days sat by his cot in scbu.

Practically - the thing I struggled with was the chairs in scbu. They were so low they were a real struggle to get out of and sore to sit in after a section. Take a seat cushion!

Sort out paternity leave. Dp took 2 days when ds was born then went back to work and took the rest when ds came home.

Make sure dp knows where your stuff is at home - I wasn't able to stay on scbu but ds was readmitted to a ward a week after discharge from scbu. I was able to stay and it was a nightmare having to get dp to rummage for everything I needed.

It is rubbish that your pregnancy will end early, I felt the same. It sounds like you had a long journey to get to this point.
You are pregnant, you did it. You will hold your baby soon and be a great mum.

Oh euro I'm with you, I also felt cheated out of the end of my pregnancy. I felt as though I had to grieve for it. I think that's natural.

I hope your little one can stay put as long as possible.

I understand about the pregnancy ending early too. I conceived after twelve yrs of infertility (and two adopted children!) and loved being pregnant. Basically I didn't have a third trimester.

One advantage of your baby being your first is that you can totally focus on them. Having to get other dc ready in the morning, doing the school run, rushing to NICU for the ward round, spending the day next to DSs incubator, rushing back for the school run, feeding and generally parenting other dc was exhausting and I wished DS was my first.

You will have few restrictions on when you can be in the NICU/SCBU we were "allowed" to be there 24/7 if we wanted to, apart from ward rounds due to confidentiality. That can be annoying as you have to sit in a little room for maybe an hr and staff don't always remember to come and tell you when you can go back in.

We got around that restriction by agreeing between us in the room (4 sets of parents) that we were all happy for the other parents to be present while our babies were being discussed. This meant we didn't have to leave the room during ward rounds. We had to keep telling the drs/consultants this and they seemed very confused by it but it worked for us. We were naturally chatting to the other parents about our babies anyway so didn't feel the need for privacy as such.

Good luck.

My son was born at 33+1 and spent 15 days in SCBU and 3 in the children's ward. He needed a bit of help with feeding, growing, temperature control and suspected sepsis but was otherwise in good condition. He's now 10months old and has a developmental delay of two months, which means he's meeting milestones when he would have done if he'd been full term. He may have problems with his eyesight, which we are seeing an ophthalmological consultant about. (Eyes and lungs are amongst the last things to develop in utero).

I would definitely stock up on very good hand cream and snacks. You'll be surprised how quickly life in a neonatal unit becomes normal for you, and you'll find a routine and rhythm that works for your family. I was very lucky and was able to stay with/near my son for his entire time in hospital (5 days I had a room on a different floor and the rest I roomed in) but it's more likely you'll have to commute or pay for accommodation near the hospital. If you haven't yet joined an NCT group, this is something to consider, as quite a few of us feel we've missed out on the support and social opportunities post-birth which attending antenatal classes would have brought. If that's not possible, there may be groups near you for SCBU families.

I am stupidly tired so I will come back when awake but I must tell you a little of my story.

I had ds through IVF (donor egg) after a long journey ttc with DP. He was born at 31 weeks by EMCS and is now 6mo and doing well although has some issues and regular pediatric reviews. He is a wonderful smiley baby and despite a tough start - I found NICU very hard - we couldn't be more 'bonded'.

I had a lot of difficulties during the pregnancy and when my waters broke at 31 weeks a lovely doctor kept saying 'its not the end of the world' and he was right.

I will be thinking of you.

hi euro

just saw this post - marking place and will come back and see if I can add anything to the great advice above.

hang on in there centime!

I think most of my advice has been covered. I had my DD at 34+5. She s now nearly 5 weeks old and a few days away from her actual due date.
She spent 12 days in SCBU. If yours ends up there definitely take a good hand cream (my hands are still totally knackered). Be prepared to move in to the SCBU if they have family rooms - if your going to breastfeed you will need to move in.
I had a couple of days where I was just totally overwhelmed - had to keep on telling myself that it was only for a very short time in her life ... But it's hard when your sitting there at 3am in the morning. But it really will pass quickly.
Good luck - hope it goes well.

Ok here are some practical tips for pre birth (I may be repeating things above)

• Take time off work now. if you don't you'll forever resent not having the lazy pre-birth element of mat leave. At least I do. Also, you need to stock up on sleep as much as you can, as you will be in the newborn phase for longer and it's knackering.

• Form a plan for paternity leave. Two days off and the rest when the baby comes home is a good idea IMO.

• Work out what you want to say to people when your baby is born. we never sent a birth announcement as we weren't sure what to say (there were various worries about dd at birth which turned out ok in the end), I wish we had.

• Get a good breast pump. You'll need to pump at home in the night if you want to establish supply.

• Stock up the freezer with easy cook meals.

• Get a small camera. My SCBU wouldn't let me have my phone on the ward which meant I couldn't take photos of DD for several days till we sorted a camera.

• Get the number of a really good breastfeeding/lactation consultant. I really struggled to BF DD - not because she was prem but because (as it turned out) she was tongue tied. Remember that not everything is down to being prem and prem babies have "normal" issues too iyswim.

• You're in London right? if you want to put centime in daycare nursery when you go back to work, or have any thoughts of private primary school, print off the forms now so you can register ASAP after birth. Sounds nuts but in my area it really is that competitive.

• I'd consider buying a Cocoonababy if you have the funds. They were originally designed for prems and help with reflux (common in prems) and to recreate the foetal position. Suspect it would have made our life a lot easier.

• kindle or books to read while expressing is a good idea.

• Look into accommodation near your hospital, if transport is going to be a nightmare.

Some tips for when you are in SCBU:

• Try to be there for ward rounds, your chance to ask questions.

• Don't google anything, at least not till you've had a proper explanation from the doctors.

• Try not to get too hung up on getting your baby home as quickly as possible (this is much easier said than done). Long term a few days or a week longer won't be important. Going home too soon can mean you are very anxious about feeding, weight etc (IME) whereas a little longer in hospital could mean you are a bit more relaxed once they are home. Also, breastfeeding tends to make it slower to get them home (as it's harder to get them to put on weight quickly) so if this is important to you, you'll need to have patience.

• Make friends with the nurses. Especially the night ones - you will feel better leaving your baby overnight with someone you kind of know.

• remember you can call the ward at any time and get an update on how your baby is.

• Take it easy on yourself. I tried to be by my baby's cot almost 24/7 and had no reserves left for when she came home. Pace yourself.

• Eat and sleep as much as you can, especially if you are wanting to breastfeed.

• I agree about the diary/notebook - I sent daily emails to DH which serve the same purpose.

Yes to wss.

Tips for sore hands to the pp whose hands are still bad after SCBU: nipple cream and a good emollient, preferably spending some time every day with cotton gloves over thick hand cream. Never, ever wipe your hands with baby wipes - it took me ages to work that one out. Rubber gloves for bottle washing.

Hi eurochick. First of all, congratulations on your pregnancy!! (I used to lurk on the lovely BESH and 10+ threads ). I'm so sorry you're having such a worrying time and I know the time before the birth can be the most worrying of all when you're expecting to deliver prematurely. It's normal and sensible to be frightened, but 31 weeks is already a good gestation, and the odds of all going smoothly will only get better as you go along.

I had my DD at 29 weeks and she was in NICU/SCBU for most of two months. It was terribly frightening at the time, although she had a smooth-ish ride for her gestation, but she's now a lovely, cuddly, bouncy one year old.

Previous posters have given lots of really great practical advice for the NICU stay, so I won't repeat that.

With regards to the birth - I didn't have a C-section but I did have a retained placenta, and I get the feeling most prem births end up feeling like very grave, very medicalised affairs. I'd read up on birth procedures fairly extensively beforehand, and I found it definitely helped me feel more in control on the day and also communicate better with the staff. If it's any consolation, it definitely wasn't the birth of my dreams, but it was still an ok birth and I feel happy thinking about it.

It's possible to breastfed a premature baby. Mine is still breastfed now! It can be a slow process, and you might end up with a gastric tube, finger feeding, and some bottle feeding - and all that's fine. It's great that you're getting expressing advice. A pump can also work for colostrum. I'd really recommend renting a hospital-grade pump (Medela symphony or Ameda Elite, if I recall correctly).

I think all 'prem mums' very much feel that their body has let them and their child down, and I can imagine that feeling would be exacerbated when you've had to go through IVF beforehand. I had great support in the hospital I delivered in, and pretty much every single health professional I spoke to in the first few days after the birth went out of their way to reassure me that it was in no way my fault, that I did nothing to cause it, that I shouldn't feel guilty, and that it was normal to grieve the pregnancy I had effectively just lost. It can be devastating having a pregnancy end early, even if the result is a baby, and I think it's important to acknowledge that. That said, the end result will be a baby, and (if you haven't already done so), I'd recommend taking lots of bump pics, shopping for baby clothes, preparing the nursery, packing a nice hospital bag, planning the birth announcement, finalising names, etc. A prem birth can feel very 'abnormal' in lots of ways, and I think doing nice 'normal' baby things before and after can be very soothing. I did some but I wish I'd done more!

On that note, and thinking of the return home, I second mini pie's suggestion of getting a cocoonababy. It's pricey, but the position is good for former perms, as it helps them bring their hands towards the centre of their body, something which they can sometimes struggle with more than term babies. They also find it comfortable and soothing, I think.

Sorry this is a bit disjointed, but please let us know how you get on. I'll be thinking of you and keeping my fingers crossed that you can keep the baby onboard as long as possible.

Thanks ladies. Trying to take everything on board. Your tips are really helpful. x