When I first got pregnant and thought about giving birth (aside from worrying over the typical birthing fears), I constantly thought about the moment when they would lift my daughter in front of me, place her on my chest, and that moment when we first saw each other, bonding as mother and daughter. The thought of that moment is powerful even today, and something I mourned over when Addie was born. She wasn’t placed on my chest immediately following her birth, she was taken by nurses, hooked up to machines, checked, poked, prodded and raced straight to the Neonatal Intensive Care Unit (NICU). I didn’t see her for 24 hours and I didn’t hold her for a week. Heart wrenching doesn’t do justice to how I felt.
Bonding is essential for normal infant development. A “typical,” full-term baby is designed to enter a bonding relationship and sends out signals for adults to respond to: eye contact, crying, smiling, noises, etc. When a caregiver consistently responds to those signals, a trusting, life-long attachment is formed. Babies who are held more during the first six months of life are more secure and confident children.
The NICU creates barriers to bonding.
The NICU does create some barriers to bonding with your baby. They may be too unstable to be held or you may have postpartum health issues of your own. Babies are literally behind a wall — a glass barrier. They may not even be in your arms. Gestational age or medical issues may also prevent them from having the skills developed to initiate or respond to your bids for bond. But building a bond with your preemie, no matter how pre-term, is possible. It just takes a little bit of creativity, a lot of determination and a wholesale mindset shift from what you were expecting when you were expecting.
1. Care for them.
This can be an overwhelming task, intimidating at first. It can take time to build your confidence, but it’s important for bonding. Whenever I was in the NICU, I did as much as they’d let me and was always asking to learn more. To start, I learned how to take her temperature, move her pulse-ox from one limb to another, wipe the gunk around her mouth and give a sponge bath. We swaddled her, learning from the world’s best swaddlers (our NICU nurses). I made a point to ask her team to wait for me to arrive every day to do some of these things and I coordinated my visits around her cares. I also did simple things, changing the bedding in her isolette or the sheets in the crib when she was moved there. By the time Adeline was ready for discharge, I could do everything, from giving enemas or medications, to working her feeding pumps. I could even change her C-PAP mask. Not only did this make me feel more like a “normal” mother to Addie during her NICU stay, it also prepared me for the daunting task of doing many of these things at home.
2. Mother’s milk.
The benefits of breastfeeding are many and well documented. And breast milk for a premature baby is even more important than for a full-term baby. Preemies are at greater risk for infections and are more susceptible to illness. Breast milk provides antibodies to help protect them. It’s also easier to digest and has special nutrients they need. Your preemie is going to need to be of a certain gestational age (typically 36 weeks) to able to suck, swallow and breath to breastfeed, but it’s so important for building a bond. Even before you can breastfeed though, pumping for them is important. Every ounce counts! When you finally can breastfeed, you release a hormone called oxytocin which can enhance a mother’s feeling of trust, love and affection. Not only will you have an amazing motherhood rush from this hormone, it also relaxes your baby as they lay against your chest and hear your familiar heartbeat. They feel loved, protected and secure while breastfeeding. I couldn’t breastfeed Adeline for the first 10 weeks, and even when she was discharged she was only able to breast feed once per day. It wasn’t until she was 7 months old that I was able to let her breastfeed whenever she wanted. Even without being able to breastfeed, the hell of pumping was worth it because I knew what I was doing was making her stronger.
Whenever I was in the NICU, I pumped beside her. This is a personal choice, because you do have less privacy than using the pumping rooms. But if I couldn’t breastfeed her, I wanted to feel as close to her as I could. I tried to make it a special time, just for us. I dimmed the lights, pulled the curtains, lowered the isolette, slid my rocking chair as close as possible, and pumped. I’d hold her hand, touch her finger, and sing or read to her while I pumped. I didn’t sit on my cell phone and check Instagram, I was just present in that moment. Amazingly, it also increased my production. Eventually, when she was older and it was easier to get her in and out of the isolette, I did skin to skin while pumping. Logistically, it wasn’t the easiest thing, but it increased my milk even more than just sitting next to her in the rocking chair.
3. Kangaroo Care.
Do this as much as possible, for as long as possible, and don’t forget about Dad! Kangaroo care was started in 1979 when the hospitals ran out of incubators. They needed a way to keep the babies warm and so they did kangaroo care. Coupled with time and a strict breast milk diet, mortality rates plunged from 70 percent to 30 percent. Skin to skin improves heart rates and assists with respiratory distress, increases a mother’s milk “let down,” improves immunity, increases weight gain, regulates body temperature and decreases chances of death! In terms of bonding, when I held her, it was the first time I truly felt like a mom. There’s also no better way to relieve NICU stress.
4. Touch them.
Give your baby as much positive touch as possible, but keep their pain levels and their immature sensory system in mind. When Addie was first born, I just wanted to stroke her body and kiss her everywhere, but I learned that was too much for her to handle. Touch can be the beginning of your relationship and can help your baby build trust in you. NICU babies are touched and messed with a lot, and it’s not often pleasurable. Your touch can help your baby calm down and learn not all touching is negative. Start small, like holding a hand or a finger and make sure to look at them, talk, or sing to them. Comfort holding is another technique. This is when you cup your hands on your baby’s head, bottom, back or feet, in order create the feeling of the walls of the uterus and give a deeper, more pressured touch. At first, try to avoid stroking, patting or even using your fingertips lightly as this can cause pain. Kangaroo care is a great way to touch, as is infant massage. There is some new evidence based research the supports the short-term benefits of infant based massage; it supports parent-infant interaction, increases weight gain, lowers stress (levels of cortisol), increases muscle tone, improves sleep, and can even lead to earlier discharge. It’s important you learn how to properly massage your infant, the nurses or a hospital PT should be able to help with the proper techniques.
5. Talk to them.
Talking to your children is so important, it helps to build their brain (which triples in size the first few years of life). There is research to support the more you talk to your child, the stronger their language skills, reading skills and even cognitive development! The easiest thing to do is just talk to your baby constantly, imitate their facial expressions, their coos and babbles, give a play by play when changing their diaper or doing any sort of care, ask questions, sing, read, tell stories, and make sure they know how loved they are with your words. This kind of activity will help you to build a relationship with your baby. I still give Adeline play by play during activities, so much so, that it’s become second nature to do this now. I even catch myself saying to John, “OK, first I am going to go to the bathroom, pack my bag and then we can leave.” And he says, “Do I need all those details?”
Besides kangaroo care, reading was the number one way John bonded with Addie. He read to her daily. Each night when he got to the NICU after work, he sat beside her and read to her. He read the entire “Winnie the Pooh” collection and all of the “Just So Stories.” I read her “The Little Engine that Could,” again and again and it had such an incredible impact. Reading to your baby builds a connection, they tune in to the rhythm and cadence of your words.
6. Pay attention to everything.
Life in the NICU can be traumatic but it’s important to pay attention. Learn what all the machines are and what the sounds, numbers and lights mean. Ask the same question five times if you need to, and learn why they alarm, and what the goal is. If possible, participate in rounds. I spoke to my daughter’s doctors every single day, and participated in rounds weekly. This helps you learn more about your baby, so you can better understand how they are feeling. When holding your baby, pay attention to their heart rate and oxygen needs. There were times holding her made her more stable, and other times when it was too much. It’s important to learn your baby’s cues, so you know if something is comfortable or uncomfortable. For a baby that can’t make noise or move much, the machines they’re hooked to are usually your best cues. A few nurses suggested we not play music for Adeline until she was 40 weeks, but starting at 36 weeks we noticed it seemed to soothe her. Even now at 2 years old, during inpatient stays, I need to pay attention to everything going on around us. I know what her typical heart rate is, and it was raised for days. Turns out she had a trauma to her uterus during a biopsy, and the heart rate was the only indicator she was in pain. It can be easier, and it’s understandable, to let your doctors and nurses handle that side of things, but there is no better advocate or voice for your child than you.
7. Sing to them.
Music therapy is rather new, and there is not a ton of research supporting its benefits, especially for preemies. But recently, a study done in NY showed music and lullabies played to babies in the NICU starting at 32 weeks gestation had improved breathing and heart rates, and improved feeding and sleeping patterns. Personally, playing music for Adeline relaxed us. Playing her music that was important to us, helped build the bond playing it for her. We made a playlist for her on Spotify and played it daily, we sang to her, rocked her, played it during kangaroo care. It made such an impact, John had one of the songs we played for her tattooed on his arm. Even if it didn’t help her directly, it helped us get through many long nights and drowned out the beeps and the whir of the NICU machines.
8. Be present.
I may be on the extreme end of the spectrum, but I lived in that NICU. I did not have any other children and was able to work from home part-time while Addie was in the NICU. I recommend you spend as much time as possible in that unit. We had the opportunity to spend the night on the floor if we signed up in advance. There were only a few rooms available, but we stayed overnight during holidays, rough days, and at least one night every other weekend. Getting up in the middle of the night to change her or pump bedside her built that relationship early. When she had her first surgery at 3 months, I sat beside that isolette all night long. I talked to her, reassured her, held her hand, and wanted her to know her mama wasn’t going anywhere. Try to be present and let go of the outside world. Put your cellphone down while your baby is awake. If you spend enough time there, you’ll realize they sleep — a lot. Instagram, Facebook, text messaging…all of that can wait until they’re asleep. Be there physically, mentally and emotionally during the times they are, too.
9. Make eye contact.
I feel like a broken record saying these things are all so important, but heck, they are! Eye gaze is one of the first milestones a full-term baby achieves, and boy is it important. When parents’ and babies’ eyes meet, an emotional connection is established. Mutual gaze is a shared communicative experience, and you can communicate your state of mind through gestures, facial expressions and smiles. When a baby sees your eyes, they start making connections between food and the feeder, voices and the person, eventually an object and a word, etc. Don’t expect eye gaze to be long, and don’t expect it to happen when the baby is tired, hungry or upset. When your baby looks at you, talk to them, sing, make facial expressions, touch them gently and try not to look away first.
10. Bring home to them and bring them home with you.
If possible, leave something with your baby that smells like you. I slept with swaddles, a small stuffed animal or nursing pads. I would keep them with me all day against my chest and then put it in her isolette near her head before I left. The next day I would take it back, and then I could smell her all day. The scent of your baby can relax you and even promote breast milk production. Try to create a “home” in the NICU. For me, it was important that all of the “stuff” belonged to Adeline. It may have been silly, but I loved having her sleeping on “her” sheets, using “her” blankets. I did all her laundry and she only wore her own clothes. NICUs live and die on donations, and many of them have clothes that have been donated through the years. When your baby starts wearing clothes, they can provide donated clothes for them. And the bedding is usually donated. But we wanted her to have her own stuff, and brought all of her clothes and bedding from home. Don’t be afraid to have all of this get dirty though — NICUs can be messy places. The stuff you bring will get messy, but it’s worth it when you see your baby sleeping on their own blankets and wearing their own onesies. We also decorated her area with pictures of us, and made it festive for the holidays. For Christmas we put up a small tree with a few ornaments, hung our stockings, and made our own little Christmas corner. It made this foreign place feel more like home.
11. Take pictures.
Looking through the lens provides a different perspective. When Adeline was born, I was unable to see her for 24 hours, so they gave me a picture to have with me. I held onto that thing for dear life, stared at it constantly, slept with it taped to my bed and began to bond with just that photo. When your baby can’t be home with you, you can look at their photos. When I held Adeline’s hand, or looked at a photo of my hand holding Adeline’s hand, the feeling was different. It gives a different perspective to things and you see things in a different light. We may have been a little crazy, but we documented every step of the journey, every day, every milestone, every event — we have a photo memory of it all.
Be the expert on your child’s condition. It will not happen overnight, but make the effort to get there. It’s important you understand the medical complexities of what’s going on. Ask questions, again and again; read articles; join Facebook groups; connect with other families who are going through similar situations. This will help you be a better advocate and ensure your child gets everything they need and thus results in a stronger bond. Form strong relationships with staff. Our favorite nurses would send me photos of Adeline when I was not there, plan special things for us (like a sleepover as a family on Christmas Eve), and had our backs. Ask for help and take advantage of the access to medical providers. Our nurses got to know us and took time out of their day to watch us, help us and give us feedback on how we were doing with everything we were doing for Addie.
Whew! I am not sure if I have PTSD, need some counseling or if this is cathartic — but I cried about 15 times writing this. It’s hard to look back and remember those unstable times, those difficult times. But I feel like sharing her story is so important and my meager wish is that this will help a family who is staring at the isolette, traumatized, not knowing what to do with the little nugget baking inside.
A version of this post appeared on She Got Guts.
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