By Rita Brhel, managing editor and attachment parenting resource leader (API)

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

It was a big day for me, my husband, and my daughter. In mid-January, seven months after Rachel was born, when she had reached 18 1/2 pounds and 26 inches long, her pulmonologist told us she was ready to come off the cardio/respirations apnea monitor that had been a constant part of her life since she left the hospital five months earlier. I was nervous, but her doctor told me that it was OK – in all his many years of practice, he had never seen a healthier looking preemie than Rachel.

It was a great compliment. My daughter was born in June at 30 weeks gestation, due to a significant placental abruption, a serious pregnancy complication in which the placenta prematurely separates from the uterus. Weighing three and one-half pounds and measuring 16 inches long, Rachel was nearly three months early.

A Traumatic Start

I had been planning a drug-free childbirth, but what I got was anything but easy, natural, and beautiful. It was traumatic for me, both emotionally and physically. I had been in the hospital for four days after hemorrhaging, and I was being treated with several anti-labor drugs, one of which (magnesium sulfate) left me so weak that I required oxygen. I was given an epidural in case I needed a C-section, and I had an episiotomy that became a fourth-degree tear and later acquired an infection. This was not the childbirth of my birth plan.

Just after Rachel’s birth, I was unable to hold her. She was whisked to the Neonatal Intensive Care Unit (NICU). I cried, begging to see her, but I was in recovery for several hours. When I finally did see her, it was shocking. She was tiny and bright red with advanced jaundice. Her head was the size of a large orange. She couldn’t breathe on her own, her heart could not beat regularly, she was unable to produce red blood cells, she could not digest milk – there were many things she couldn’t do.

She was covered in wires and tubes. I was surrounded by warmers and incubators full of tiny babies, doctors telling me about her complications and about her chance of survival, and nurses running to the constant beeping of a monitor signaling that some little baby was in dire need of attention. Many times, those alarms were signaling that the baby in danger of dying was my little girl.

What I Could Do: Kangaroo Care and Pumping Breast Milk

And this was my introduction to parenthood. The last part of my pregnancy, my childbirth, and the care of my daughter were completely out of my hands.

That was, until a couple of the nurses at the hospital introduced me to Kangaroo Care. It was a week after Rachel was born that my husband and I began this skin-to-skin contact, where the naked baby is placed on the chest of the parent and covered with a blanket. My husband and I noticed that Rachel’s breathing and heartbeat evened out during Kangaroo Care, and that if she was fussy or having trouble sleeping, she would calm down right away and slip into satisfied sleep.

For my husband and me, Kangaroo Care was a time for us to get to know our daughter. And it was the start of my emotional healing. I had felt enormous guilt for giving birth preterm, and I had refused to let myself get close to her for fear that she would die. After starting Kangaroo Care, I realized I wanted that emotional bond and that I wanted to know Rachel, even if the story didn’t end well.

I also started pumping breast milk for Rachel. Breast milk is superior to formula for all babies but especially for preemies. Breast milk reduces the chance of infections, clears up complications faster, and helps prevent the dreaded, extremely fatal intestine-destroying necrotizing enterocolitis. Because Rachel was born so early, I was developmentally not ready to breastfeed. At my first pumping, I was thrilled to get three milliliters. I persevered, pumping every three hours around the clock and filling the hospital freezer full of my milk.

Tips to Helping Your Baby in the NICU

• Feed breast milk, either by breastfeeding or pumping.
• Sleep with a cloth against your skin at night to get your scent on the cloth, and then put the cloth in your baby’s isolette or crib for her comfort.
• Provide infant massage.
• Help with procedures by using your hands to contain your newborn if she has to be un-swaddled. Also, hold a pacifier in place if the procedure requires that you cannot nurse.
• Provide Kangaroo Care, which is holding your unclothed baby against your bare chest, skin-to-skin, with a blanket around the two of you.
• Ask for breaks if a procedure is taking a long time, or if you’d like someone else to try the complete the procedure.
• Keep a log of daily events and changes in the care of your baby, including procedures, medications, and other treatments being done.
• Ask to have a consistent group of nurses to care for your baby. Build meaningful relationships with your baby’s health providers.
• Ask to have the tube put through the nose instead of the mouth, to ward against the risk of oral aversion, the refusal of allowing anything including the breast into the mouth.

Going with my Instincts…and Against Professional Advice

I was advised several times by nurses to skip the pumping and just mix formula to get more sleep and recover faster myself, but I was adamant that Rachel be fed breast milk, even if I couldn’t breastfeed her myself. Rachel did end up getting two bouts of infection – a very scary ordeal – but I believe she wasn’t nearly as sick as she would have been, and she recovered faster, than if she had been on formula.

Tips to Helping Your Preemie Learn to Breastfeed

• If your baby isn’t ready to take breast milk by mouth, pump your milk and, in the mean time, put your baby to the breast to smell your scent and root around.
• If your baby is receiving nutrition through a feeding tube, put your baby to your breast during the tube-feeding.
• Use the hospital’s lactation consultant to help keep your milk supply up while you’re pumping and then to help you and your baby learn to breastfeed.
• Keep a log of how much milk you collect at each pumping session so that when your baby begins breastfeeding, you have an idea of how much milk he is receiving.
• Rent or buy a quality pump to use at home.

I visited the hospital every day. Early on, a nurse told me that the babies went home quicker when their moms were around. I was staying at a Ronald McDonald House, since my home was two hours away. I came to the hospital early and left late. I sat by her incubator, (eventually her crib), reading to her, touching her, holding her, changing her diapers and clothes, helping with her feeding tube and medicines, answering her cries and praying for her. Few mothers kept vigil for their infants as I did.

There was a doctor who criticized me greatly for being around so much, saying my daughter couldn’t tell if I was there or not, but I knew in my heart that she did. She had less apnea (cessation of breathing) and bradycardia (slowing heartbeat) when I was around, the nurses said. And when I talked to her or spoke her name, she would turn her head to look at me. She didn’t do that with anyone else.

A Look at How Far We’ve Come

For two months, I lived at the hospital. Complications came and went, although some have hung on longer than others. Teaching her to eat, as preemies aren’t born with the instinct to coordinate their sucking and breathing and swallowing, was especially tough. I prayed through the tough days and celebrated every success, no matter how small. Finally, Rachel came home at the end of July, weighing just under six pounds.

Tips for Going Home

Leaving the hospital can be just as scary as entering. You’re leaving the security of your medical support system and will be making decisions about your baby’s daily care on your own. It’s normal and appropriate for you to feel insecure and to question your readiness. To help alleviate some of these feelings:

• Take a CPR class.
• Schedule a home health nurse to visit often during the first couple of weeks.
• Make a home care schedule that fits your life at home and allow a couple days for a trial period during the last few days in the hospital. In some hospitals, this “reverse rooming-in,” where the parents stay in the room with the baby, is required before discharge.
• Receive training in the procedures and treatments that need to be done at home, such as using an apnea monitor, or administering medication for acid reflux.
• Bring a cooler to transport your frozen breast milk home.
• Practice putting your baby in the carseat. Many hospitals require a carseat check before discharge to see if receiving blankets need to be packed around the baby to make the seat secure, as well as to determine if the baby will be able to breathe while upright. If a problem occurs, some babies can still be released but must use a special cars bed that allows the baby to remain lying down during the trip.
• Once home, give your baby a tour to allow him to adjust to the new sounds and smells. Keep one of the blankets from the hospital near her so she has the comfort of the smells she’s familiar with. Keep your home at about 72 degrees Fahrenheit until your baby is better able to regulate her temperature. You may also need to clothe her in layers, keep a hat on her bed, or keep her swaddled in heavier blankets than you’d think for the weather; monitor her temperature often to be sure she’s not too hot or too cold.
• Avoid comparing your baby with other infants’ development who did not spend time in the NICU.
• Continue to accept help as long as you can. Depending on medical conditions and required procedures, the transition home may be much more difficult and tiring for you than it would be with a newborn who did not spend time in the NICU.

For a month, we had in-home nursing care. And then, we were on our own. Rachel still had some problems, a heart murmur, an eye condition, continued apnea and bradycardia, gastro-esophageal acid reflux, but we have seen most of these disappear. Only her acid reflux remains. She has caught up to her peers developmentally, sitting in the 90th percentile for size. She is a very healthy preemie.

I owe it to Attachment Parenting (AP). I believe the techniques that I used in the hospital helped give her a will to live. Once home, I fully embraced AP and that’s when I saw her weight gain explode.

In the preemie world, weight gain equals maturity in the body systems, which equals resolution of many of the complications. For Rachel, a huge part of her medical conditions was that her brain wasn’t mature enough to tell her lungs to keep on breathing and to tell her heart to hold a steady rhythm, so the more weight Rachel gained, the more mature her brain became. However, weight gain is often complicated by feeding issues: Rachel was just too weak to suck for long, and energy was lost on crying. The less crying, the more weight she gained.

AP Makes Sense

AP was an easy solution – it came by instinct. While practicing various AP techniques, I found that her apnea, heart-rhythm irregularities and acid-reflux spells lessened. I have been doing my best to follow each of API’s Eight Principles of Parenting, since I came home. Here’s a few of the AP practices I incorporated into caring for my premature baby this first year:

• Feeding with Love and Respect – I was never able to breastfeed, but I did pump for four months until I ran into supply issues. Then I researched formulas, finding a way to mix my own from several types to create one that lessens Rachel’s acid reflux but is as close to breast milk as I can get. I also let her drink her milk on demand. Every feeding is done in my arms and on my lap with plenty of eye contact and snuggling.
• Ensuring Safe Sleep, Physically and Emotionally – Because Rachel was in a high-risk category, she couldn’t sleep in my bed for many months. For the first three months, I slept in a sleeping bag on the floor of her room, thinking that I’d eventually get emotionally comfortable with sleeping on a sofa just outside her room. But I never did, and finally my husband moved her crib into our bedroom. I don’t foresee this situation changing very soon, and now that she’s bigger, I sleep with her in my bed when she’s restless or sick or just otherwise wants to.
• Using Nurturing Touch – Rachel never took to any sort of sling, and once I got her into a carrier, it nearly broke my back, so she finds a nice, comfortable spot in my arms whenever she likes. I tote her with me everywhere, and the few times she isn’t being held, she’s in a bouncy seat or on a blanket on the floor right beside me.
• Responding with Sensitivity – I am always keyed into Rachel’s feelings. If she wants to play, babble, sleep, eat or anything, I am right there, ready to help. Crying in our house is a very rare occasion, as my husband and I know Rachel’s pre-cry cues inside and out. Illness, an acid-reflux attack, and too many loud relatives are her crying triggers the rest of her needs are fulfilled long before the crying stage.
• Providing Consistent and Loving Care – My husband and I take great pains to avoid separation from our daughter. I quit my job as a newspaper editor and started a home-based freelance writing business. My husband left his demanding nursing home management job to focus on his vegetable farm at home and took up a part-time job in telemarketing with shifts that fit around my work schedule, eliminating the need for daycare. It was a tough adjustment to quit a job I loved and go to a lifestyle with a lot less cash flow, but I’m much happier now. I like being my own boss. Plus, we don’t have to worry about potentially deadly viruses (for premature infants) found at daycares and childrearing philosophies that differ from our own. It has taken a lot of creativity and resourcefulness to make it work, but it’s worth it. I want Rachel to grow up knowing me as the center of her world, just as I knew my mom who stayed home with me and my siblings. I didn’t want to share that position with anyone else, except my husband.
• Striving for Personal and Family Balance – Keeping ourselves well-rested, well-fed and emotionally stable are goals that my husband and I continually strive for. All babies can strain parents and their marriages at times, but preemies and other special-needs babies are especially so. I am not only Rachel’s mommy, but also her nurse. In the early months when Rachel’s medical conditions weren’t so stable and I was recovering, it was especially tough on my marriage. My husband and I work hard to keep our marriage strong with daily devotionals and special time for ourselves after Rachel goes to sleep at night. But we also need time for ourselves. For me, that’s doing volunteer work or attending a local playgroup. For my husband, that’s spending time with his fishing, woodwork- ing, and gardening projects. And for both of us, that’s get- ting enough sleep, cooking healthy meals, and taking the time to hop into the shower or take a walk.

Attachment Parenting has worked out well for me and for my daughter. I still receive criticism from all sorts of people that I’m spoiling my daughter by holding her all the time or not letting her cry it out, that I’m setting myself up for interrupted and sleepless nights later on when my daughter wants to crawl into bed with me, that my marriage will suffer, that my career will suffer, and the list goes on and on.

But all I have to do is look at my daughter, at how happy she is, and how happy I am and how much she has overcome, and I’m completely confident that AP is the reason.

Bonding with a Newborn in the NICU

The anticipation of your due date, your birth plan, and delivery are so important during your pregnancy. But fate doesn’t always follow our plans. Instead of that ideal mental picture of a perfect birth, some parents find themselves thrust into the unfamiliar territory of a hospital setting. If the baby comes early, or if there are complications at birth, the baby may require help with his breathing and feeding, sometimes in a Neonatal Intensive Care Unit (NICU).

Parents may experience feelings of fear, inadequacy, and isolation as they enter a hospital setting. The tips provided can offer knowledge, promote bonding, and inspire confidence during the unexpected consequence of hospitalization.

You have special qualities that no health care professional can match: strong love for your baby and a familiarity that she finds calming. Because you are the constant at the bedside every day, you become the expert. You will be amazed at how often you will be called on by your health care team. Asking questions, taking care of yourself, and becoming involved as much as you can will promote quicker discharge, and in the process it will begin to empower you to take your newborn home.

Make the Hospital Your Second Home
You’ll be spending quite a bit of time at the hospital until your baby is ready to come home. Be sure to become familiar with the hospital and NICU by learning:

• Where long-term parking is located.
• About sleeping accommodations for visitors.
• The availability for pager for use when you leave.
• The chain of command for doctors, nurses, and support staff.
• The hospital schedule, including times for medical updates.
• Where you can gain Internet access.
• About visitation procedures.
• How the tubes, wires, and monitors help the health care team to care for your newborn.

You are Your Baby’s Advocate
A big part in knowing how to best make medical decisions for your baby is to keep up-to-date with her conditions and to make sure you understand the ins and outs of the diagnosis, prognosis, procedures, and treatments of that condition. Be sure to:

• Ask the professionals to repeat information until you understand.
• Write down information for later reference.
• After receiving a report, ask the health care professional to return at a later, specified time to discuss new concerns or questions.

Get Support for Yourself
In order for you to best support your new baby, you need to take care of yourself. This means sleeping, eating healthily, and using a support system. Other tips include:

• Take breaks away from your baby’s bed side.
• Call your baby’s nurses as often as you would like, even in the middle of the night, if you go away from the hospital. If you feel more comfortable having someone at your baby’s bedside when you’re away, ask a family member or friend to stay in your stead and to write down what happened while you were gone.
• Write down your questions and ask the doctors to call or page you with the answers.
• Make lunch dates with other parents for support. Connect with like-minded parents through your local API Support Group or through the API Forums, www.attachmentparenting.org/forums.
• Learn more about caring for a baby in the NICU through other AP-friendly organizations such as March of Dimes, www.marchofdimes.com, or La Leche League, www.llli.org.
• Designate people to help you by taking meals for you at the hospital, making meals for your other children, updating family and friends about your baby’s care, bringing personal care items and mail from home to you at the hospital, cleaning the house, mowing the lawn, caring for the pets and plants, and other daily tasks.
• Stay connected to your other children through notes, phone calls, e-mail, and visits.

Remember Your Children at Home
Children often feel guilt, jealousy, resentment, anger, neglect, and regression surrounding their new sibling’s birth – let alone a baby in a NICU taking even more of their parents’ time away. Ways to help your other children cope during this time include:

• Maintain routine, encourage open communication, and help them talk about the hospital through play.
• Provide photos, comfort items, and a special reminder of you such as a shirt or voice recording while you’re away at the hospital.
• Alert teachers, coaches, and club leaders about the changes and stresses in their home life.
• Invite them to visit the new baby. Show them photos of the new baby, tell them about the hospital, and encourage them to ask questions. Prepare them by reading stories about what it’s like to stay in or visit a hospital.
• If your children visit the hospital, allow them to set the time limit and let them know about hospital guidelines beforehand. Afterwards, encourage your children to express their feelings about the visit through talking, playing, and drawing.
• If your child decides not to visit the hospital, support this decision until he’s ready. Encourage this child to connect with the new baby by drawing pictures or doing a voice recording.

By Jennifer Smith, RN, co-author of One Step at a Time and Life’s Toughest Moments