When Olivia was born, she was placed in an isolette (think incubator). At 30 weeks gestational age, she was unable to control her own body temperature. At first, she had a sensor on her that registered her body temperature. Her isolette would automatically adjust the temperature inside of it accordingly. Then, so she had to work a bit, they took off the sensor and set the isolette at a certain temperature. (Remember from my last post that they want babies to have to work a bit, but they really want them to grow. They find a balance so they are working, but also still growing.) Every three hours, her temperature was taken. If she was too cold, they'd turn the temperature up a bit. If she was too hot, they'd turn it down. Gradually, they continue to turn the temperature down until they are confident that Olivia could maintain her body temperature without any assistance. Then, she graduated to a crib. She moved to a crib on day 14 of her stay.
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| Olivia in her isolette. It's difficult to see, but their are two holes in the back of the picture where you can put your hands through. The other side has the same thing. The sides also drop down so we could get her out to hold her.
Let's talk about holding this sweet girl! Everyone in the NICU encourages parents to do kangaroo care with their child. This means that you hold them skin-to-skin. Benefits from this care include stabilizing the baby's heart rate, improved oxygen saturation levels, more rapid weight gain, improved sleep, and more. We did A LOT of kangaroo care! Olivia always had this sweet look of pure joy when we were holding her! So sweet. The nurses and doctors encourage parents to do as much of the cares for their child as they feel comfortable with. Every three hours, I would change her diaper, take a temperature, and do any other cares that might be necessary. If it was bath day, I could give them baths as well. It's so hard to have to say good-bye to your baby everyday so for me, it really helped to do as much as I could.
The other scary, but super normal, thing that 30 weekers do is forget to breathe and have heart rate dips. When this happens, the alarm beeps begin! Most of the cords you see in pictures are to monitor vitals. The monitors have parameters set and if a baby's oxygen level, heart rate, or blood pressure go outside of those parameters, the alarm sounds. It's honestly enough to drive a person mad. Scott was obsessed with watching the monitors constantly. Because I was there all the time, I learned not to look at them unless they beeped. I got really good at knowing if one of their "stickers" had moved and it just wasn't picking up. I also got pretty good at moving them back to a spot where they would pick up again. However, when it was a for real, it was scary. Olivia almost always popped her levels back up right away. Occasionally, she would need stimulation, but it seemed to happen at night so I never witnessed it on her. (Jack's another story!) Basically, the nurse would gently massage her chest to remind her that she needed to breath. If she had one of these, it was called a "spell." Olivia actually received caffeine to help with these issues. Around 34 weeks gestational age, they stopped giving her caffeine because most babies gain the ability to remember to breath all the time around this age. Of course, when we were getting close to bringing her home, she started having a few more spells. If she had a spell, she earned herself at least 3-4 days in the NICU because they obviously don't want to send you home with a baby that's going to forget to breath. To ease everyone's mind even more, they did an extensive breathing test right before she came home to make sure that her breathing patterns were regular.
Feeding. I'm sure almost all mothers of preemies will tell you that feeding is one of the most stressful parts. Everyone tells you that one day they will just get it. But it doesn't feel like that when you are in the thick of it!
In the first weeks, Olivia received all of her feeds through a feeding tube. Every 3 hours, she would get the amount the doctors had set for her. Most days, the amount was increased a little bit. I was fortunate enough to be able to pump enough breast milk for both of the twins to have. They would fortify my breast milk with a special type of formula. What does that mean? Breast milk is about 20 kcal/oz and by fortifying it they can make it 24 kcal/oz. This helps babies because they can get less and still reach their kcal requirements.
Most babies don't learn how to suck and swallow until around 34 weeks so we had almost a month before we could even work on feeds. Around day 26 of life, she became interested in trying to breastfeed. Breastfeeding is intense, but it is even more intense in the NICU. Before you try to breastfeed, you have to weigh the baby. Then you feed and when you are done you have to weigh again. They have a scale that can measure how much milk the baby got because they have to record everything the baby takes in. I hated this. I would think that Olivia did an awesome job and then I'd weigh her and she's have taken just a few mL. It was so discouraging. She never did get breastfeeding while we were in the hospital, but once she was home it went better. However, the very first bottle she took was an entire feed! That means that if she was supposed to take 50 mL she did all of that orally with the bottle. What a stinker. If she wasn't able to orally take the amount she was supposed to, then she would receive the difference through her feeding tube. When she was taking almost all feeds orally, she was able to move to an ad lib schedule. This meant that she could eat when she cued and not on a 3 hour schedule. But she still had goals to meet regarding how much she took in. Once she was took all of her feeds orally (and met her goal) she was cleared to go home!
Oh, and bottle feeding a preemie is not just putting them in your arm and tilting them back. We worked with OT's (occupational therapists) to learn the proper way to safely feed Olivia. First, you put them in a side laying position. Then, you have to pace the feed for them. Otherwise, they get too eager and keep sucking and forget to take a breath. We would let them take a few sucks and then tilt the bottle so they couldn't get anymore. The OT's worked to find bottles and nipples that worked the best for them. They are really AMAZING people!
Olivia's OT's also worked with them to stretch out their muscles. If Olivia would have been in the womb, she wouldn't have been fighting gravity. The OT's work with the nurses on positioning the babies if they notice anything peculiar happening (think flat heads, etc.) Olivia's feet also turned inward due to the way she was positioned against Jack so they did stretches on her feet and ankles and also taught me how to do everything so I could continue the stretches at home. Her feet still turn in slightly and drives me bonkers. I always bring it up and her doctors feel confident that once she is walking and standing on them all of the time she will natural straighten them out.
The NICU was set up with many different nurseries. They moved several times depending on the level of care they needed and how many other babies were in the NICU. Each nursery had 8-10 babies depending on it's size. There are no doors in the nurseries. Each baby has enough space to have a recliner/rocker chair next to the baby. For privacy, you pull a curtain around your area. The twins were always next to each other so our space was larger. A few days before we anticipated Olivia would be ready to go home, they offered us a room to stay around the clock with her. I couldn't leave Jack in the nursery alone so they let him come to the room, too. After Olivia was discharged, he moved back. The picture below is their cribs together in the boarding room.
Do you notice that they are both laying at an incline and are wrapped in a funny thing? Many preemies struggle with reflux and are put on "reflux precautions." The means they tilt their bed. To keep them safe, they use a danny sling. (It was invented by a mother of a boy, Danny, that had severe reflux.) It straps to the bed and then you velcro in the baby like a burrito so they can't roll down the bed. We had to go through a class about reflux precautions and using the danny sling at home, too. Olivia really struggled with reflux when we got her home. After each feed, we'd have to hold her upright for 15-20 minutes. If we didn't, she was so uncomfortable and would often spit up. Olivia is in the danny sling in the picture below. The towel in the shape of a circle in the corner of her crib was placed under her head to help with it's shape. We were worried for a while that she would need a helmet, but her head shape turned out great.
Olivia spent 54 days in the NICU and was 38 weeks gestation when she was discharged. She weighed 6 pounds 13 ounces. It was a bittersweet day because we were so excited to get her home, but had to leave Jack behind. Thankfully, they allowed Olivia to come to the NICU with me each day to see Jack. They even found a bassinet to keep by his crib so I had a place to put her when I was snuggling, feeding, and working hard to get him home.
Olivia a few days before discharge. She had to pass the carseat test!
Exactly a year later!
Meeting BIG sister!
Thanks for reading about Olivia's stay. It certainly was not the way we would have chosen to have her start her life, but we are so thankful for the wonderful care she received in the NICU at The University of MN Children's Hospital. Olivia is a happy and HEALTHY little girl. If you've had the privilege of meeting her, there's no doubt that she's given you a big smile with a face that just lights up. Her nurses often used the word "spunky" to describe her. I think she's going to keep us on our toes!
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