Category Archives: NICU

win a night with a baby warthog!

let’s talk anatomical development! ramona’s mucus membranes are starting to mature, which means she is producing mucus. lovely, huh? but that also means that she has all this snot & she doesn’t know what the fuck to do with it. it was kind of cute at first, because it just made her snore these adorable baby snores. but then she had a not-so-cute snot explosion all over her face & started making these intense snorting noises when she was both asleep & awake. they are the kind of noises that would embarrass the shit out of you if they were coming from your great-uncle murray at your cousin’s wedding or whatever. but they are coming from a tiny baby who doesn’t have any comprehension of her actions.

honestly, the warthog impression doesn’t bother me too much. i know she’s not doing it because she’s unhappy or even necessarily uncomfortable. it’s just a phase, until she learns how to clear her throat effectively. she’s not asphyxiating or anything. we’ve been giving her nose drops & suctioning out her nose on the regular (enough that she doesn’t even mind it anymore). but i guess the snorting really bothers jared.

it bothered him so much last night that i decided i would just sleep on the couch with ramona next to me in her bouncy chair on the floor & let jared have the bedroom for the night. we’ve been sharing the nighttime baby load pretty evenly. we go to bed no later than 10pm, & trade off getting up with her throughout the night. she usually wakes up three times between 10pm & 7am. i get up with her at 7am & jared usually sleeps for another hour or two. (i kind of lose my mind if sleep in too long, especially if i’m going to bed so early, regardless of how much ramona keeps me up in the middle of the night. i found her feedings really onerous when she first got home, but now we have a rhythm. she sucks down her bottle & then i read while i pat her back until she burps & falls back to sleep. it’s not a bad way to spend an hour at 3am.)

however, ramona seems to be going through a growth spurt because she wanted more bottles than usual. jared gave her one at 11pm, & then i took over. she wanted a bottle at 12:30am, 1:30am, 2:30am, 5am, & finally again at 8am. i got up with that last one (an hour later than usual, which already had me all stressed out) & put coffee on. jared got up shortly thereafter & immediately launched into a litany of complaints about how hard it is to sleep when she’s snorting & how stressful it is to feel responsible for stopping the snorting. i wanted to say, “are you fucking serious? you just slept for eight hours straight. i haven’t slept for eight hours straight since NOVEMBER, & let’s be serious, more like MARCH if you factor in all the pregnant lady nighttime peeing. do NOT talk to me about how hard it is to sleep when i got up with this little beast FOUR TIMES last night. ALONE.” instead i just sipped my coffee & asked if he had any suggestions for how to address the problem.

i went into the kitchen an hour later to top off my coffee & try to tackle the rest of the day…& the coffee was gone! jared drank it all. even though i shouldn’t have been surprised–we bought a new espresso maker right before ramona was born specifically so we could share coffee in the morning without having to make multiple batches–i’d gotten into the habit of finishing all the coffee on my own in the morning because i was usually up for several hours before jared. & i am usually better rested in general because he was helping take care of her in the night. instead, i’d done all the night care solo & only got half the coffee. & we were out of espresso so i couldn’t even make more until one of us went to the coffeeshop for a fresh bag. i started crying. i told jared i felt resentful of him for not helping with the baby the night before & then finishing the coffee, even though i had volunteered to take care of her alone & hadn’t asked him to leave the coffee for me.

i decided it would clear my head to go for a walk & get more coffee, so off i went. when i got home, jared was lugging a hamper of damp laundry up from the basement, telling me the dryer had conked out halfway through its job. this is never good news, but especially when you are cloth diapering a baby that goes through like twelve diapers a day. he started stringing up a clothesline in the living room, like we’re living in some kind of lower east side tenement circa 1910, but i called the landlady, who immediately came over & fixed it.

& then i called the tiny k people. i guess they do assessments of premature babies & help their parents figure out how to best stimulate & interact with them to optimize their development throughout early childhood. it’s a free county service & ramona was seven weeks premature, so…why not? i have been reading a lot of books lately about premature babies & NICU experiences. they are written by people whose babies are much more premature than ramona. she was born at 33 weeks; most of these authors had their babies at 24 weeks, 25 weeks, 26 weeks. in the world of premature infants, a single week can make a monumental difference. but it’s still sobering to realize just how early ramona was, & how many bullets we managed to miraculously dodge (knock on wood–with preemies, sometimes developmental delays or behavior/health issues don’t show up until the child is older). it makes all those early congratulations we received on our “healthy baby” all the more incongruous to me, even though i was in denial at the time & was just like, “thanks!” i talked to jared about it & he admitted he had been very concerned about ramona’s health, in a way i never was, probably because i never saw her on the ventilator (i was too sick to visit when she was on it) & was on too many drugs to really take it all in when she was having other major interventions. by the time i was off the percocet & actually able to pay attention to ramona’s health with any degree of real comprehension, she was on room air, her central line was out, she was over her jaundice…she seemed perfect to me. just small.

is breast still best if it comes exclusively from a bottle?

i included a space on my to-do list to write a blog post about ramona’s third week of life, but she’s 25 days old now–halfway through her fourth week–& i want to write about something a little more immediate & relevant to my own life. guys, having a baby is difficult. not that i didn’t think it would be. it’s just difficult in a different way than i was prepared for. in a kind of a meta way, i was prepared to be unprepared for the difficulty, but it’s still tough.

the big news is that ramona really started getting the hang of mouth feedings last week. the main things she had to do to be released from the NICU were a) maintain her temperatures without help, 2) pass the car seat test, & 3) take all of her feedings by mouth. they delayed starting her on a bottle for a few days so that i could work on breastfeeding her. we did board one night so i could try her at the breast at every feed for 24 hours. sometimes she really took to it; more often she took a few sucks & then fell asleep or thrashed around until she got a bottle. but by saturday, she was taking entire feeds from the breast, no supplementation necessary, & she could suck down an entire bottle in like thirty seconds flat.

jared & i remembered different things about when her feeding tube could be removed. he thought they had said that a baby needs to take all feeds by mouth for 48 hours, but in the discharge binder (my source of info, considering how little i remembered of the discharge class, which i attended while still on two percocets every four hours), it said 24 hours. once ramona hit 24 hours with no tube feedings, i asked to speak with a nurse practitioner to clarify the issue. she looked at ramona’s chart & said she’d write an order for the tube to be removed that night. “& we might as well do the hearing test too. & the car seat test. & i’ll leave the paperwork for the hep B vaccine with you. &…do you guys want to room-in tomorrow? & then she can go home the next day?”

so, long story (well, maybe not so long) short, ramona was released from the NICU yesterday. she’s been home with us for a little more than 24 hours now.

& it is really hard.

rooming-in was hard too. i don’t know if all NICUs do this, but overland park regional medical center has some rooms actually in the NICU where parents can stay overnight with their babies in preparation for going home. the parents are responsible for all their baby’s care during the rooming-in period, just like they would be at home. they change all the diapers, take care of all the feedings, administer baths as necessary, dispense any medications or other tests. if all goes well & baby comes out the other side alive, having gotten all its medication, maintaining its temperature, & eating okay, it can leave.

the tough part is that we were still on the hospital schedule. in the NICU, ramona’s temperature was taken, her diaper was changed, & she was fed every three hours around the clock, since birth. if she pooped her diaper fifteen minutes after having it changed–tough luck, kiddo. unless the poop actually seeped through her outfit, she was left to sit in it until the next diaper change. (& the NICU nurses seemed surprised when she developed a diaper rash. go figure.) if she got hungry before feeding time–too bad. she’d have to wait. needless to say, this is NOT how i would have parented her at home. but we had to chart her temps, diapers, & feeds NICU-style during the rooming-in, so we had to more or less stick to their schedule. & it was hard because she didn’t eat that well at her first few feedings, so she kept us up half the night screaming for food. seriously, she screamed almost non-stop from 12:30am until 5:30am. when i did put her to the breast, she was too hysterical to take to it & we wound up giving her a bottle (of breast milk–i am still pumping around the clock & had milk in the fridge). she calmed right down for the bottle & slept like a log once she’d finished it.

anyway, now she’s home, so i can feed her at will & exclusively at the breast, right? my whole plan when i was pregnant was to exclusively breastfeed. when the NICU insisted we have a “bottle system” ready to go before they would discharge it, i kind of mentally dismissed the idea, thinking we’d buy some bottles to honor the request but just never use them (except for the occasional dad feeding).

but it’s just not working out. she cues for food, i offer her the breast, she latches on for about ten seconds, & then she whips her head away & screams. i try a different position & the same thing happens. lather, rinse, repeat until both of us are near tears & finally i break down & give her breast milk in a bottle. she polishes it off in no time & falls asleep like the happy, satisfied baby i wanted at the breast.

i have no idea what to do. she is capable of maybe two or three decent meals at the breast in a day (though none yet today), but no way would she be taking enough calories that way. & i have to admit, being able to give her a bottle & know she’s eating is a huge sanity-saver. she’ll nurse fitfully at the breast for an hour or more & take about the same as she’ll take from a bottle in three minutes. in the middle of the night, desperate for sleep, the bottle looks like my best friend. & i justify it by telling myself that she’s still very small & doesn’t have a lot of stamina, & my supply might just be too much for her to handle direct from the breast, & we have plenty of time to make the transition as she gets bigger & stronger & my supply evens out to adjust to her actual needs, & in the meantime, she’s still getting breast milk from the bottle. & it also means that jared & i can split feeds evenly, which gives me more time to myself (to think about what a failure i am as a mother, that i can’t even breastfeed my own baby despite having enough milk to fill the grand canyon).

i’m going to consult with my doula once the holiday is over, & i’m going to attend a la leche league meeting & see if anyone there can help me out. maybe it’s ramona’s size. maybe i’m not positioning her properly. maybe she needs some extra time to adjust to the sudden change in environments & caretakers. maybe this is normal for premature babies. maybe it’s okay to just keep pumping & giving her bottles of breast milk until she’s weaned. maybe this just isn’t a big deal. but it makes me feel really sad & crappy.

ramona balogna: week two

ramona balogna, ten days old.
ramona balogna, ten days old.

ramona’s second week of life was much more difficult for me than her first. she continued to improve by leaps & bounds on a daily basis. i haven’t been worried about her health at all (which is an enormous blessing). but without the percocets to take the edge of the surreal experience of having my newborn daughter in the hospital, i definitely struggled.

first, let me explain the NICU for those that have never had the experience. it’s an entire floor of sick &/or premature babies. some of them, like ramona, are considered pretty large & robust. her neonatologist said that ramona is considered large & in charge for a NICU baby, tipping the scales at nearly five pounds at that point (she’s five pounds, five ounces now–maybe more, depending on what she’s gained in the last 36 hours). the proprietor of the baby consignment store down the street, where i stopped in to pick up some preemie-size sleepers for ramona, told me about a friend of hers that had a 15-ounce micropreemie in this same NICU. that baby is home now, six months old, & finally weighing in at eight pounds. because these babies are so tiny & sometimes so sick, of course there are a lot of shellshocked, emotionally exhausted adults wandering around.

there is a parent room at one end of the unit. it’s a tiny room, like the size of my bathroom, & trust me–my bathroom is not large. there’s a couch, a fridge, a TV, & two microwaves in there. one microwave is for heating up food. the other is for sterilizing breast pump supplies. there are also cabinets full of snacks like crackers, fixin’s for peanut butter & jelly sandwiches, hot cocoa packets, microwavable soup, etc. there’s a basket of magazines & a bunch of brochures about premature baby care, infant CPR classes, grief support groups, WIC, etc. a “private room” for a NICU baby is a little room with a dimmer switch & a curtain, in a block with a bunch of other similar rooms. ramona has one of the best set-ups because she shares her block with only three other babies. in the older part of the NICU, the blocks contain twelve babies. each room is outfitted with an isolette or a crib (depending on the baby’s ability to maintain its own body temperature–a crib baby is a more advanced baby), a bunch of monitors that record the baby’s vitals, a glider, a table where the nurses/doctors can take notes, a plastic mailbox for parents, a trash bin, a linens bin, & a crappy rolling chair. this takes up pretty much all the real etsate in the room, & you have even less space if you have a really sick baby requiring more equipment, like a ventilator. the nurses will recommend that you not put anything on the floor, because it’s a hospital & who knows what kinds of terrifying strains of MRSA are on the floor. if something, like a hat, a burp cloth, or a boppy, gets dropped on the floor, they will suggest you take it home & wash it. if you are anything like jared & i, you are spending a minimum of five hours a day, & sometimes up to nine hours, at the NICU. which means you have kind of brought a lot of stuff with you. because, yeah, you’re going to be holding your baby a lot, but your baby is tiny & needs to sleep a lot, & it is going to be examined regularly by doctors & nurses, & it will have to be in its bed then, & you will have downtime, so you will need to have a book to read, or a “new yorker,” or maybe your journal, or your computer. plus some snacks or leftovers from home so you’re not trying to care for your NICU baby on nothing but a steady diet of club crackers & lipton tea. don’t forget that you’re not allowed to eat or drink in the baby’s room, even if you are breastfeeding or pumping (which really consumes calories–the thirst & hunger associated with pregnancy is nothing by comparison). nor can you use your phone in the baby’s room. so all those well-meaning texts & phone calls you are receiving from people who want to know how baby is doing just pile up until you’re done with the NICU for the day, at which point all you can do is think about how good it will feel to go to sleep after your 40-minute drive home, so when you look at your phone & see all the texts that you should answer, you just want to throw your phone through a wall.

jared & i brought in a set of plastic storage drawers to try to make some space for ramona’s stuff. at eight days old, she was finally allowed to start wearing clothes, so we brought in a bunch of sleepers from home. it was kind of rough because she was already dressed when we showed up on her eighth day of life. her first outfit, & we didn’t even get to choose it ourselves. to top things off, our nurse that day kind of sucked. she kept saying that ramona was a little chilly in her isolette (they like the babies to maintain their temperatures between 36.5 & 37.5 degrees celsius & ramona was around 36.3), & therefore she had to stay in her isolette & we couldn’t hold her. even though kangaroo care (skin to skin) is recommended for warming up premature babies & we were happy to do it. i also got the okay to start putting ramona to the breast that day, & the nurse was surprisingly unsupportive. she seemed really uncomfortable with the idea of walking in to ramona’s room to make a note on her chart or check her feeding tube & find me sitting there with a breast out. but there are a lot of babies in the NICU & i see other NICU moms sterilizing pump parts all the time. i’m sure there are a lot of exposed breasts happening behind those curtains. get over it, lady.

ramona's first outfit! probably not the one i would have selected, but i wasn't there.
ramona’s first outfit! probably not the one i would have selected, but i wasn’t there.
ramona's first ever attempt at breastfeeding! she did awesome.
ramona’s first ever attempt at breastfeeding! she did awesome.
"no photos, please!"
“no photos, please!”

that was kind of a taster of what the week would bring. i struggled a lot & cried almost every day. as i became more aware of what was happening around me, with the nurses & some of the other NICU parents & some of the written & unwritten rules of the NICU, i had to adjust to more & more stuff & process more & more information. on top of continuing to recover from surgery. on top of never getting more than two & a half hours of sleep at a time because of my pumping schedule. on top of the emotional upheaval of being separated from my baby. i routinely felt physically exhausted but emotionally wrecked by the prospect of going home so i could go to bed.

breathing 100% on her own & cuddling with daddy!
breathing 100% on her own & cuddling with daddy!

ramona balogna: week one

ramona is only fifteen days old as i sit here to write this, but the first week of her life is already a blur. i was still in the hospital for half of it, recovering from surgery & having my blood pressure monitored. i was at home on percocet for the rest of it (to help control incision pain). i didn’t think much of it at first, but in retrospect, those percocets were something else. i told jared that i am feeling much more awake & clear-headed now that i’ve switched to naproxen (which i used to take for arthritis pain–it’s basically just extra-powerful tylenol). he replied, “yeah, there’s a reason why no one does naproxen recreationally.”

first of all, allow me to say that it kind of blows my mind that anyone would ever intentionally have a cesarean. obviously i have read a lot about pregnancy & childbirth, even before i was pregnant, because it’s an interest of mine. but i read a lot about it while i was pregnant too. i even made the mistake of reading several books critiquing the increasing medicalization of pregnancy after i had been diagnosed with pre-eclampsia (but before i wound up in the hospital). these books go on & on about the “epidemic” levels of unnecessary cesarean & the hot trend of women choosing to plan their cesareans in order to have more control over their schedules, or even to facilitate a certain astrological sign for their babies. before i had ramona, i was like, “damn, that’s crazy. who would do that?” now that i have first-hand experience with the surgery…seriously, who would do that?!

obviously i have not had the experience of a vaginal birth to compare it to–maybe it also takes weeks to recover from that & maybe it causes persistent excruciating agony. i mean, i don’t want to scare anyone. sometimes cesareans are necessary & unavoidable–like in my case. & obviously i am alive & i’m sure i’ll eventually make a full recovery. it’s not like it was an unbearable experience. but i’d never had surgery before & was pretty unprepared for how it might feel to recover from having someone cut open your abdomen & pull out an entire human being. it was a few days before i could stand up. it was a few more days before i could stand up straight. fifteen days later, i still have lingering pain & am taking naproxen every eight hours. i still have to walk slowly & not try to lift or carry anything too heavy. because of the painkillers, my doctor recommends that i avoid driving, & i’m supposed to wait another four weeks before i start taking baths & going to the pool. i have to gently wash the incision site every day & pat it thoroughly dry & apply antibiotic ointment. it’s healing well & the doctor says she doubts it will scar much, but it’s some crazy shit, that’s for sure.

but thank god for those percocets. they really took the edge off the stress of having a baby in the NICU. ramona was only four days old when i was released from the hospital & we had to start the daily grind of loading up the car & driving to kansas city every day to see her. after i was first diagnosed with pre-eclampsia/pregnancy-induced hypertension, about a month before i landed in the hospital, i of course panicked to a certain degree & sought out stories of other women with pregnancy-induced hypertension who had managed to get to term & deliver nice healthy babies that didn’t end up in the NICU. it was tough because any time you have a pregnancy complication, all anyone wants to tell you about is their cousin’s neighbor’s hairdresser, who had that exact same problem & delivered at 32 weeks & the baby is doing great now but it was in the hospital for two months, etc etc. i finally put my foot down & said, “i know my chances of getting to term are not great considering that this diagnosis is being handed down at only like 28 weeks, but i am not ready to think about having a premature baby yet. i don’t want to hear stories like this.”

two days old & on CPAP--exactly what i did not want to imagine while i was pregnant.
two days old & on CPAP–exactly what i did not want to imagine while i was pregnant.

as a result, i was completely unprepared for everything that happened. & the drug fog made it so i didn’t really have to deal with it right away. jared observed that my personality was completely different. i was simultaneously totally laid-back & also incredibly assertive.

& for those first few days that i was home, ramona was under the jaundice lights, so it only made sense for us to be at the hospital for two feedings, tops, since we couldn’t really hold her much or interact with her. she couldn’t even look at us. that gave me a chance to try to pull my life back together at home–pay some bills, empty my desk drawers of pregnancy-related paperwork & binders & replace it all with baby-related binders & paperwork, do laundry (or put it in a hamper & get jared to do it), etc. so the full reality of the fact that i had had a baby, & she was in the hospital, & she was going to be in the hospital until further notice, was kind of on a delay.

a little kangaroo care between rounds under the jaundice lights. six days old.
a little kangaroo care between rounds under the jaundice lights. six days old.

ramona came off the jaundice lights when she was a week old, & we were allowed to hold her for more than an hour a day. she still had a nasal cannula in to help assist with her breathing, but they were gradually turning down the power on that & encouraging her to breathe on her own. she liked to pull the cannula out & stick it in her mouth. she was one week old when she started cuing too–opening her mouth wide & jamming her fingers into her mouth during feeds (she is being fed through a tube wound down her throat still–she doesn’t have the stamina for mouth-only feedings yet). & her week birthday was only our third day as non-hospital visitors to the NICU, so we were still learning the ropes.

one week old! done with the jaundice lights!
one week old! done with the jaundice lights!
one-week birthday snuggles with mama.
one-week birthday snuggles with mama.
one-week birthday kangaroo care with daddy.
one-week birthday kangaroo care with daddy.