While your baby is still in the Neonatal Unit

Always use calm movements

Hold your hand gently over the baby as this helps the baby feel embraced and secure rather than stroking movements or massage as these can overstimulate a premature baby but are excellent once they are older.

Preventing the frog position – knees bent and apart and feet turned out- when placing the child on its back by supporting arms and legs in slightly bent position

Placing the baby on its side, changing between right and left sides, preferably with a rolled  up cloth nappy between the legs as this can prevent bodily asymmetry.  It is also beneficial to place the baby in the foetal position as often as possible as this will improve the childs ability to bend its body later on.

Rolling the baby when it has to be turned from back to front and back again, in order to strengthen symmetry.

Bathing the baby with a cloth nappy wrapped around the body in order to give it a feeling of being safe and encompassed, in a narrow bath so that the baby can feel its boundaries or so the feet can feel the edge of the bath.

Placing the baby on your stomach, skin to skin, to train it to lift its head and to give it bodily contact

Rocking the baby gently both while embracing it and when it is lying in a hammock or cradle as this will stimulate the sense of balance and help with brain development.  If the baby is embraced, for example, in a carry sling, its breathing and heart rhythm will be stimulated and anti-stress hormones will be released in the baby’s body

Letting the baby lie in a sack chair or on a beanbag cushion gives the feeling of being embraced and for stimulation of the sense of touch.

Cross training by gently moving right arm and left leg towards each other and then the other two limbs, this is repeated until the child indicates that it has had enough.  Cross training assists coordination between the right and left hemispheres of the brain, a function that the child will need when it learns to crawl and later develop other motor skills

Once you are home with your baby

Letting your baby play with and in water stimulates several senses in particular the sense of touch

Giving your child the chance to swing, crawl, hop, run and play on the floor, particularly in bare feet help to develop the balance and gross-motor skills

Letting the child lie on its front over a swiss ball and rolling the ball while holding onto the child’s feet help to stimulate sense of balance

Playing in the countryside where the child can move to its own rhythm has a positive and calming influence on the mind and the chance to move at its own pace is important for the rhythm and harmony of the child’s body

Letting older children stand on one leg, play hopscotch, climb up, hop down, balance along a wide line or a thick rope and catching a big ball with both hands develop the gross motor skills, the coordination of the senses and balance.

Letting the older child draw and paint, play with lego, play dough, puzzles will help develop their fine motor skills.  Playing in the sandpit or letting your child play with twigs and stones and seashells are also good natural materials that give the child a good sensory experience and at the same time strengthen their fine motor skills.

Letting the child use eating utensils by itself as soon as possible

These suggestions of training and stimulation of the senses and motor skills and avoidance of over stimulation are general, there are many others.  A child with delayed motor development should have a training program tailored to its needs by a therapist.

Ref: Born Too Early by Jonna Jepsen

4 hours old

At my routine 20 week scan I could tell that something wasn’t quite right as the technician kept rescanning and measuring my baby – but of course she wasn’t allowed to tell me anything,  I had to wait until my midwife got results and she told me that his long bones in both arms and legs were measuring very short.  Two days later I was referred to a specialist at Hastings hospital who told me that it looked as though my baby was going to be a dwarf and offered me a termination – I was horrified at this offer because to me this was no reason to terminate.

At 21 weeks I was sent to see a specialist at Wellington Hospital. After scans and an amniocentesis  I was then sent home to await the results which would take 10 days.  After 10 days I got a phone call saying that I needed to go to Wellington the next day for the results.

I was told that they had found Cytomegalovirus in amniotic fluid but it wasn’t in my blood.  Again I was offered a termination and this time I had to consider it as this virus does serious damage to the baby’s brain.  I asked for another amniocentesis just to make sure and after waiting another 10 days for the results they told me that it was all clear and that the first results were incorrect.   I was then asked what I wanted to do as the baby was still not growing properly.  I told them that I would be continuing with the pregnancy and if it is meant to be it will be.

Lochie 2 weeks

For the next six weeks I travelled to Wellington every Thursday for a scan . The specialist had determined that my placenta was very small and was not functioning properly. On  the last two trips I was also given blood transfusions to try to help my placenta – hooked up to a drip for 6-7 hours and then having to drive 3.5 hours home was not much fun but if this was going to help my baby I was happy to do it.  The specialist wanted to try to get me to at least 32 weeks and the baby at least 500gms.  At 500gms they say babies are viable.  At every scan it was fingers crossed that he was still growing and that my placenta was still doing ok.

Finally at 27 weeks I was told I could not go home and was admitted to the hospital where I was scanned every second day and on foetal monitor twice a day.  During my time on the ward I was fortunate to be shown the Neo Natal Unit, as I am sure it would have been so overwhelming if I had not previously seen all the equipment involved in keeping premature babies alive.

On the afternoon of Wednesday 8th August 2007, just 6 days after being admitted,  I was told that I was going to be having this baby in a few hours by c-section, he had more chance of survival on the outside. At 8.53pm Lochie arrived weighing 690gms and was put into an incubator and taken to NICU.   690gms was a huge bonus as he was scanning at only 500gms.  It was another 4 hours before I was able to go see him.  When I finally did get to see him he was so tiny and hooked up to tubes and monitors.  Thank goodness for my previous visit to NICU!! He was ventilated but during the night was transferred onto the Midline CPAP on room air.  This was the start of my life revolving around the NICU.  I became involved in Lochie’s cares washing his face, changing nappies and changing his probes when ever they needed doing .    I had to wait for 15 days before I was able to have first cuddles with him. This was great but with prem babies it can all change so quickly so it was not always an option – if Lochie was having a bad day, then cuddles were not available.  It is always said with prem babies that you sometimes take 1 step forward and the 2 steps backward – I found this was often the case.

Lochie had low blood sugar, jaundice and chronic lung disease.  He had lots of apnoea’s & bradycardia requiring stimulation to get him going again.  He also had lots of blood transfusions (I think 6 in total).

On day 22 I noticed that Lochie looked a bit blotchy and mentioned to the nurses, he then had a lumbar puncture and they then had to tell me that my son had viral meningitis – I didn’t hear anything else they told me apart from that dreaded M word.  Lochie was back on the ventilator, feeds stopped, antibiotics started and on a brain monitor.

After a few days he is starting to feel better and so is back on the CPAP but feeds of 2mls 2 hourly don’t start again for another 5 days.  Head Ultrasound shows that a bilateral grade 2 bleed has developed after the meningitis.  Scanned again in a few days to make sure not getting worse and has stayed at a grade 2.

After spending 2 months in Wellington NICU Lochie was transferred back to Hastings SCBU this was a great day but also a very sad day.  Great that he had made such great progress but very sad that we had to leave all the great nurses and doctors that I had trusted with my son’s life and also sad to say goodbye to the other families that I had met while staying at Ronald McDonald House – although we are still in touch with them.

Arriving at Hastings SCBU was a very tough change for me – even though I was now closer to home, the staff didn’t know my son and all I wanted to do was go back to Wellington.

Lochie, What a handsome boy!

Lochie progressed very quickly and we started breastfeeding within a week of arriving back – great to finally not have to be hooked up to a breast pump 4 hourly!!!  Two weeks before being discharged Lochie decides he doesn’t need an extra oxygen so he his taken off nasal prongs.  This was great but also strange as I wasn’t used to seeing his face without tubes and tape all over it.

After a month in SCBU I am finally allowed to take my little man home weighing 2.3kgs.  Very emotional day!!!

Today Lochie is a very happy little boy and I am so thankful that I have him.  His development is delayed and he has been diagnosed with mild cerebral palsy due to the brain bleed he had.   Lochie has therapy once a week and we are about to start a 6 week intense therapy course for him at Conductive Education in Auckland.

What is kangaroo care?
Kangaroo care is a way of holding a premature baby so that there is skin-to-skin contact.  The baby, wearing only a nappy, is held upright against the parent’s bare chest.  The name kangaroo care is used because the method is similar to how a baby kangaroo is carried by its mother.

Where did it start?
Kangaroo care began in South America, where premature babies were sent home snuggled between their mothers’ breasts, being fed only breastmilk.  The method spread to countries in Europe and then to the United States, where an estimated 200 neonatal intensive-care units practice kangaroo care, up from about 70 in the early 1990s.

Why is it used?
Kangaroo care is often used with premature babies because the close contact with the parent can stabilise the baby’s heartbeat, temperature and breathing.  Premature babies have a hard time coordinating their breathing and heart rates (often called coupling).  As the baby’s heart rate increases, there could be an increase of apnea, which is a temporary loss of breathing.  Studies have shown and many medical professionals agree that kangaroo care can help the baby better coordinate its breathing and heart rate.

Kangaroo care and breastfeeding
Mothers who use kangaroo care can have more success with breastfeeding and improve their milk supply.  Premature babies (particularly those less than 34 weeks gestational age) often suck better at the breast than the bottle, because premature babies are usually not able to control the flow of milk from a bottle.

Remember to eat lots and drink plenty of water.  As long as you are expressing at least 6 times a day you should keep up an adequate milk supply and expressing at night time is vital to maintain your supply.  The maximum time between expressing should be 4 hours initially.

If your milk supply decreases do not give up hope.  With perseverance and by expressing more frequently your milk supply will increase.  Hand expressing as a change form using a pump may provide your body with the tactile stimulation needed to stimulate the production of breast milk.  You also don’t have to experience the sensation of “let down” to successfully breast feed your baby.

Here are some other ways that may increase your milk supply:

- Placing hot face cloths on your breasts for a few minutes before you express can help stimulate the release of milk.

- Expressing after a shower of bath

- A herbal tea called Lactagogue tea made by Weleda also helps

- NaturoPharm also have tablets called “Milk Flow”

- Tigers Milk is also reputed to  increase breast milk.

The recipe for Tigers Milk is:  1 litre of milk, add 1 raw egg, 2 table spoons of honey, 1 mashed banana and 1 tablespoon of brewers yeast.  Mix well and keep in the fridge.  This milk shake will last one day.

If breast feeding doesn’t happen for you and your baby, don’t worry about it.  This is a very stressful time and trying to breast feed under such circumstances can sometimes be too much.  While breast milk is the best food for your baby breast feeding may not be the best for you.  If either you or your baby are not happy with breast feeding then the stress involved with persevering can be too much heartache for both of you.  Try not to let yourself feel guilty as a happy and contented environment is what is best for your baby and that means a happy mother.  Some people believe bonding only happens with breast fed babies but this is untrue, mothers bond beautifully with bottle-fed babies too.

Good luck and email me if you have any questions about this

Karlyn