Here’s What to expect in the NICU

Perhaps you are still pregnant and have developed a complication that may lead to your baby being admitted to the Neonatal Intensive Care Unit (NICU) after birth.  Or perhaps your baby has just been born and is admitted already. The truth is that this was probably not part of your plans when you decided to fall pregnant. In this article, we discuss what to expect in the NICU.

The NICU can be a very scary place at first and it can be overwhelming to see your baby for the first time in an incubator full of monitors, lines and machines. Oh, dear NICU mommy, it is ok to feel scared and overwhelmed.  I too have gone through this experience and I want you to know that it’s going to be ok. Yes, it’s going to be hard sometimes but you will make it to the finish line.

One thing I remember about the first day I walked into the NICU is that I had absolutely no clue what happens in the NICU and I definitely did not know the “’NICU language”. I decided to write this for new NICU mommies, to help you cope with this frightening situation. Here are some guidelines to help you interpret the NICU language and also what to expect in the NICU.

Please note before reading further

There are many reasons why babies are admitted to NICU. Being born too early is the most common reason, but there will also be babies who experienced complications during the birth process, were born with an infection, had mild breathing difficulties or who have congenital abnormalities.

Although some little ones may be very ill, many others are simply there to help them overcome some small glitches. This article offers some general information from the point of view of a mother who has gone through the experience and who truly understands what to expect in the NICU. But the care you receive will obviously be unique to your baby’s situation.

You should also know that the current outbreak of COVID-19 has had a major impact on how things are done in hospital units, including the NICU. Each hospital will have its own protocols, and you would have to speak to the unit manager to find out what these are. It may well impact on their hygiene protocols and visiting times. We can only wait for this difficult time to pass.

Here’s what to expect in the NICU

Arriving in the NICU:

You will be asked to wash and sanitize your hands once you enter the NICU, to prevent your tiny little baby from getting exposed to any harmful bacteria. Babies in NICUs are very vulnerable to infection, and proper hand hygiene reduces the risk of this happening. Due to COVID-19 you will also need to wear a face mask and possibly a protective gown.

Your baby is very small and you will probably not be able to touch or hold your baby for the next few days.

What to expect in the NICU at 24 – 28 weeks

At this stage, your baby will be very thin, with fragile red skin covered with downy hair (lanugo). His head will look large, he will have soft skull bones, and a small face with a pointed chin and eyes fused shut.

What to expect in the NICU at 29 – 34 weeks

Your baby will still be quite thin, and his skin will be slightly translucent and still covered in downy hair. In girls, you may see tiny nipples. He may move quite vigorously and grasp your finger and may be able to suck or lick, but he won’t be ready to feed on his own.

What to expect in the NICU at 35 – 37 weeks

By this stage, your baby will be much more robust and will look more like what you’d expect a term baby to look like. He may still be quite thin, with some hair, and he may still need extra help with feeding and breathing and staying warm.

Your baby will be in an incubator or under and overhead warmer for the first days or weeks of his life. This is to keep his body temperature stable.

Depending on what medical support baby needs, there may also be:

  • A ventilator to help with breathing
  • Machines which give measured amounts of fluids and medicines to baby through tubes going into their veins
  • Various monitors attached to baby to measure temperature, heart rate, breathing and the amount of oxygen in his blood
  • Special cooling beds to help reduce brain injury in babies who have had a difficult birth

All of this technology and machinery keep baby comfortable and allows the medical personnel to care for them without unnecessarily handling them. This because they will grow best in an environment as similar as possible as mommy’s womb, which was dark, less noisy and without constant disturbance.

The monitors have alarms that will let medical staff know immediately when baby needs extra care. The alarms may go off a lot, which can scare mom. Usually, it won’t be serious.

Other large machines are brought into the NICU when they’re needed. These include machines to:

  • Take x-rays and ultrasounds
  • Monitor brain function
  • Give babies phototherapy for jaundice

Ideally, a NICU should be a calm place, with nurses and doctors quietly looking after the babies and other specialists coming in and out. Cell phones are not allowed, and conversation should be muted.

Feeding babies in NICU

Most babies will have an infusion (drip) to provide them with fluid and in some cases nutrition. Straight after birth, this drip will be inserted into the naval or umbilicus, using the blood vessels that connected baby to mom’s placenta in the womb.  Later this drip will be inserted into other veins in babies’ arms or scalp.

As soon as possible baby will be put onto oral feedings, preferably breast milk.  Having a baby in the NICU usually means you can’t nurse right away, and you would need to start expressing breast milk as soon as possible to stimulate your milk supply and to provide baby with colostrum for early feeds. These may be given through a syringe or through a feeding tube that goes via the nose into baby’s tummy. IF baby cannot feed yet this colostrum can be frozen until he is ready.

The NICU staff are usually very helpful with this early expressing process, but if you struggle, ask to see a lactation consultant. Initially, you can express by hand, but within 2-3 days you will really benefit from using a good quality electric breast pump.

Most NICUs will have hospital-grade electric pumps at hand, for which you can simply buy the hand kit and then use the communal pump. But you will need a pump for when you are not at the hospital, or for when you are discharged if baby is not exclusively breastfeeding yet. Speak to a lactation consultant for guidance on which pump to buy.

Your doctor may also prescribe a medication to help stimulate your milk supply.

Feeling involved and connecting with your baby in the NICU

Giving birth to a premature baby can be incredibly stressful and it’s easy to feel disconnected. Remember that you are baby’s mom, and that you play an incredibly important role in also helping them through this experience.  It is natural to feel like the nurses are taking over. A mother’s instinct is to provide and care for her new born baby. In the NICU this might not always be possible.

The NICU staff will give you the schedule of when they will change baby’s nappy and feed baby. Try to be there to feed (hold the feeding tube) and/or change your babies’ nappy.

Ask the nurse to show you how to reconnect the pulse oximeter as it can easily fall off.

Read a book or sing to your baby so that baby can hear your voice.

Do as much skin-to-skin with your baby as possible. Studies have shown that skin to skin is not just amazing for bonding, but also improves milk supply and has MANY other advantages for premature babies.

  • It helps them cope with stress
  • More stable heart rate
  • It regulates their body temperature
  • It improves the nervous system functioning
  • More stable sleep patterns
  • Better cognitive control
  • Regulates heart rate and respiration
  • Reduces post-natal depression in mom
  • Improves weight gain

Acknowledge your emotions

It’s ok to allow yourself to cry, laugh, scream and be angry – no emotion is right or wrong. Talk to your friends or join a NICU support group where other mothers can share their stories and support you during this difficult time. Mommies who have been through this experience themselves truly understand how overwhelming it can be.

Take care of yourself

The saying goes “you can’t pour from an empty cup’’. So take care of yourself.  Make time for a warm bath or shower, eat healthy and comforting food, drink enough fluids, and rest, rest, rest as much as you can!

The last word

The NICU journey is a step process, many forward and many backward, but witnessing the determination of a premature baby fighting for life with each breath they take is life-changing for parents and those around them!

You are strong and you will get through this; you will walk out of those NICU doors even stronger!

And remember miracles do exist!