Reduced growth - told to give birth any day to under 3lb baby. Anxious

[AnxiousKeziah]

Hi,
Name changed but am a regular. Have a 3yr old ds and expecting ds2 in mid May. But due to reduced growth and uterine artery issues I have had steroids and told be prepared to deliver any day I go to hospital, or if I concerned about movement to go in. Baby estimated at 2lb 7oz currently at 29 weeks.

Very anxious.
No idea what to expect. See anaesthetist next week and scan next with consultant. Not had a your of NICU offered yet.
Am very worried about going home 2/3 nights after a section with a GA ( which had last time and home after that timescale) and not being near the baby. And not feeling great.They are always so short of beds on post natal ward and they do not have accommodation for parents like other hospitals. But it is my nearest - so 30mins away.

Really want to feed baby. Had delayed lactation with first dc so was already a concern. Do they promote this or offer practical help? Thanks.

Really hope can get a few more weeks. If results on scan stay same or improve told will have to deliver at 34 weeks latest, if any decrease in growth or worse PI function will deliver next week.

How scary for you. I had a 30 weeker last year (went into labour with v little warning) and had emergency section as DS was coming out bum first. He was half an oz over 3lbs. Is there a reason why you would have GA rather than an epidural? If it's an option, I'd take it as it may help with recovery time. I can't lie- being discharged from hospital and having to leave DS there was bloody awful ( they actively discouraged pre-34 weeker mums from staying as there is v little you can do apart from sit by the incubator, I got to stay there after about 4 weeks to start establishing BFing and because the 1.5hr round trip was seriously affecting my already wobbly mental health). It's heart wrenching but it does make sense for you to try to rest and sleep as much as possible particularly as your main job will be to express. Expressing is v much actively encouraged as pre-34 weekers are too immature to BF and so you should be given lots of support. Don't worry too much about a delay in your milk coming in as most units can offer donor milk for the first couple of days and preemies have teensy tiny amounts to start with. We switched to EBF after about 12 weeks and have never looked back.
Really hoping that you can hold on for another few weeks.

Oh sweetheart - a massive hug for you.

I would suggest ask the hospital about accommodation. I was able to stay on postnatal for 10 days to be near DD when she was in SCBU, i think this is unusual (most mums want to get home I think) but worth asking. Is there a Ronald McDonald house anywhere nearby? If not - will there be someone who can take you to/from hospital in the first week or two?

What to expect - well there is quite a wide range depending on how far you get and how small or poorly your ds2 is. Bliss website has some very helpful info as does the Tommys website. Your baby is likely to go into an incubator and may need help to breathe, to keep warm and will have various wires to monitor oxygen etc. he may be fed via a nasal tube or an Iv drip at first. There will be regular heel prick blood tests and other tests such as retinal test and brain ultrasound - all scary but normal. Doctors do rounds every day so you can ask questions.

my hospital were very positive about breastfeeding esp for prems and I was shown how to hand express colostrum and then use the (very effective) hospital pumps. from about 32/33 ish weeks they are often strong enough to try to latch and so you can do BF followed by tube top up. ask about hand expressing pre birth - they may say this is a good idea to bring on milk or they may say not to in case it triggers birth, I'm not sure. You could also ask about donor milk for first few days.

Hope the next scan brings positive news and dc2 can stay in a bit longer.

I had a 30 weeker last year, 2lb 11oz he's doing really well and is a right little bruiser now! We were in two different hospitals and both really supported and promoted BF. Good luck x

Thanks. Encouraging to hear of all your LO's doing so well.

I have 2 appointments coming up early next week so will try and ask all my questions. Really want to bf so thanks for tips and things to ask.

I had to have a GA with first dc due to complex health issues for me sadly and am hoping we will know whether essential by early next week. Getting a second opinion from the anaesthetist I had last time now as had a bit of a disaster appointment regarding it. I want to be with the baby ASAP but know it is not quite so simple!

My dh will be able to drive me initially. But have a toddler also - keeping him in childcare but do not have any for school holidays. And only 3 days a week covered, but it is a start! I will ask how long I can stay on post natal ward as a few extra days there will help ( instead of 2 nights!).

My head is just spinning! It is the lack of knowing that has come so suddenly. All I know is have to take bags on Tue and be prepared to deliver - and hoping scan results improve so get another week or two to get my head around it but more importantly for baby to be ok and grow!!

Thanks.

can see it will be tricky with a toddler. Can your DH defer his paternity leave so that he takes it in school hols and/or when dc2 comes home, as thats when you'll need him most I would think. hope you get the extra time on post natal and hope they look after you!

as a pp says, there is not much you can actively do before 33 ish weeks other than express (which can be done at home - ask about hiring a hospital grade pump) so please don't beat yourself up if you can't be at hospital all the time. I was there a lot (first child) but saw other mums who came in for a couple of hours a day and that was totally normal - in fact I sent myself a bit nuts being there so much.

I think dh will get some compassionate leave or could take unpaid leave. My natural instinct is to want to be at the hospital all the time with the baby - not sure I could cope being at home until the baby is out of NICU. Which is not going to help me but I just know what I am like.

Definitely want to be able to express - took 10 days to have any milk with dc 1 so will ask for help with that before I am discharged - otherwise no idea who to ask.

Weirdly one of the very few pluses of having a premmie is that you get a big window of time to bring your supply in before they actually need much. It took me half an hour to get my first 0.5th of a ml for my 27 weeker dd, by the time she was ready to regularly bf I was getting 1.2 litres a day! So much I donated most of my stash to a milk bank.

And did she take to bf after such a long time not bf CrazyQ? That is a fear I have - that this baby will not take bf after tube/bottle.

Keziah I think bottle does make it harder to shift to BF (though I have seen stories on here of women who have bottle fed ebm to get their prems home but then successfully swapped to Bf once home) but tube doesn't seem to have this effect. One tip I have seen is to ask the nurses to do the tube feeds while you BF (or attempt to Bf) as that way the baby associates the full feeling with BF.

in terms of being home without the baby - it's tough, of course it is. My suggestion would be to spend the time you're in hospital getting to know the nurses who have charge of your DS as much as possible as that made me feel a lot better about leaving. Also you can call the ward at any time to get an update on how he is doing.

I was in this position last summer. At 28 weeks we knew there were problems with PI in the uterine arteries. I was then very closely monitored and we made a decision with the drs at each appointment how to move forward. It was a balancing act between keeping her in as long as possible and not leaving it too long as the consequences could be catastrophic (not trying to scare you- I am sure the risks have already been explained). We managed to keep goingbuntil 33 and a half weeks when the blood flow deteriorated and the Drs advised getting herboutbascsoon as an incubator became available cage was born at 34 weeks exactly, weighing 3lb6. The six weeks between finding out there was a problem and the delivery were the most stressful of my life, so I really feel for you.

I was discharged after 36 hours. She was in for just over 3 weeks. I was happy to get out as I detest hospitals. However, visiting was hard some genius put the neonatal unit as far as possible from the car park so I had to do the long slow c section shuffle through the hospital several times a day.

She wouldn't take bottle or breast to begin with. She had a day of formula and then my expressed milk. She didn't get the hang of breastfeeding so I continued to express. She finally latched on, by chance, when she was 4 months old and I was thinking about starting to mix feed as I needed to go back to work. I think I probably could have switched to breastfeeding then, but couldn't risk putting her off bottles at that point! In the end she was fed solely on expressed milk to five and a half months and is still mix fed at seven and a half months.

I'm happy to answer any questions if I can it is a difficult place to be and I find all handholding and support welcome.

Sorry no first hand experience, but friend who had premie twins said that the sucking reflect doesn't kick in developmentally for a few weeks. If you research about it you can be prepared to find the right window when they're ready. Good luck.

She did OP. Tbf tube feeding has no impact on future bfing so long as they time the feeds for during or after a bfing attempt. Bottle feeding can potentially cause problems, and I really fought against it, but eventually agreed to some feeds done that way when I wasn't there after the nurses raised fears of her choking on beak feeds (like a wee cup with a spout), I also had to battle to get her off a four hour schedule in her final days, which again is useless if you want to bf. The way we did things the nurses or my husband bottle fed her (she came home on one top up feed of prem formula a day, for added weight gain, but never took more than 30mls so we were allowed to ditch it after three weeks), but I never did I only ever bfed her so she always associated me with that way of feeding. I also used something called a supplemental nursing system (Google it) to make bfing easier for her in the early days at home.

AnxiousK, I too was v concerned that wouldn't be able to BF or that DS would be confused after tube/bottle feeding but NICU reassured me that it really isn't an issue and that as far as they were concerned the concept of breast/bottle confusion is a bit of a myth. Because of low birth weight and slow growth to due septicemia halfway through his stay they supplemented my milk with a Breast Milk fortifier which he continued to have mixed into my expressed stuff until he reached a decent weight. They will encourage you to start trying to get your LO to suckle after about 33 weeks gestation but wouldn't expect him/her to really be that successful in getting milk until 35/36 weeks and even then they would struggle to feed for long enough to really thrive (preemies tire v easily). I don't think we'd have been home until my DS's due date if he'd been exclusively BF, just because he wasn't strong enough, bottle feeding meant that he could get home sooner and it really wasn't hard to make the switch. You'll be fine.

We bottle fed expressed milk to get dd home - she couldn't latch on and if we'd waited for her to be bf well she would have been in scbu until about a month after her due date! I think it's all about doing what's right for you as a family, given that it's not the easiest place to be. I was really beating myself up about it not working and my mum had to keep reminding me that I'd still have a beautiful, growing baby even if it didn't work. The nurses wouldn't /couldn't offer me a bottle though, they had to wait for me to ask - I'd assumed that it wasn't an option and so didn't ask until I was in tears in the early hours trying to bf her, then within 5 minutes she was gulping down my milk from a bottle, and home by the end of the week. She's still bf at 14 months, which I never expected!

I also bottle fed to get my baby home. But on the contrary the nurses were pushing bottles and did the first one without asking me when I wasn't there and had mad it very clear that I wanted to bf!

Thanks for all information on bf and bottles. I will have to make it clear I want to bf, and hope they work with me. Know there is a specialist midwife for feeding but not sure if I can get to see her. Will ask though!

Sadly scan results worsening and looks like I will deliver a baby under 3lb in the coming week. Hope to meet paediatricians/learn about NICU care on Thu. But nothing booked yet.

Sorry to hear that, good that you will have got past 30 weeks. I hope you get some information from the paeds soon, in the meantime do ask anything here xx

It sounds like they are keeping a close eye on you, which is good. My baby did much better on the outside. They often do. I know this is such a scary time though.

Thanks. Awaiting results of the Amnio as that will help them interpret results correctly - they are unsure if it is a chromosome issue ( was 1:40 risk plus had one soft marker at anomaly scan) or a placenta issue. Growth of abdomen had stalled inbetween last 2 scans - which were 8 days apart.

More anxious than before. Had Amnio on Tue, result back Thu/Fri - but they may have to deliver on Thu without results we were told of the blood flow/PI ( unsure of right term!) is worse. Now above the top centile sadly.

I'm sorry to hear that. I don't have any experience of an amino or chromosomal difficulties, but if it is "just" IUGR due to placenta function issues, the babies tend to do very well on the outside where they can be fattened up!

My PI was off the chart on both sides. How is your umbilical blood flow? They focussed on this for me after about 28 weeks.

My PI is off the chart. The blood flow has resistance - using phrases like A wave in ductus venomous and cerebral resistance and absent end flow in some diastolic loops. Not sure what they mean as I only got the notes as we left, but it was explained simply to me that it is ok for now but abdominal growth had stalled and they now looking at delivery in 7 days max rather than up to 5 weeks if things were stable.

Am nervous about results today/tomorrow. Would love an extra week - but totally hear your Eurochick about how stressful this time is. I am struggling to keep calm but know I have to.

Hoping I do not develop pre-eclampsia before delivery as that is a symptom of placental insufficiency and do not want my health to dictate birth. Desperate for baby to be healthy, but feel guilty saying that. Have a 3yr old at home ( waited 7 years for him and so blessed to have him).

What pumps did people use to express bf at home with! I have a Medea mini electric from ds. Or would I need something different?

I hope you've managed to get some more answers today and that you're feeling as ok as you can in the circumstances.

I just used a standard electric pump (think it was avent?) but the hospital might be able to loan you a bigger/faster/double pump if you want one.

The hospital should be able to loan you a big green industrial type pump - although in the early days hand expressing is best. Am so sorry baby's coming sooner than later but agree if it is iugr that these babies really can thrive once out. Dd was 2lb 4 at birth but dropped to 1lb 15oz but after a long journey (she wasn't iugr she was v prem) she totally rocks my world. Good luck to you both x

Absent edf in all loops was the point for me where they said they would get her out as soon as an incubator was available. They said that on a Saturday and I had an awful few days of being on standby. She was born on the Thursday night.

To begin with, I was at the hospital so much, I mostly used the expressing room there. Then I hired a pump from a website called ardo I think, that my midwife recommended. They delivered really quickly.

I hope you are doing ok, well as much as you can be ok with all this going on. X