Transcript: Inside the NICU: What To Expect

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Twin Talks
Inside The NICU: What To Expect

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

NANCY MEYERS: Well most new born twins don’t need to spend time in the NICU. It’s always helpful for expectant parents to be familiar with it in the event that it is needed. It’s nice to have questions that answer the head of time like: “What are all those machines? Can I even hold my baby?”

I’m Nancy Meyers, a neonatal nurse and manager of Tri City Medical Centre talking today about: “The NICU, what to expect?” This is Twin Talks Episode Number 5.

[Theme Music/Intro]

CHRISTINE STEWART-FITZGERALD: If you’re pregnant with twins or you’re an experienced twin parent, odds are you have heard it all before. Now, it’s time to hear from the experts. This is Twin Talks, parenting times two.

Welcome to Twin Talks broadcasting from the Birth Education Centre of San Diego. Twin Talks is your weekly online on-the-go support group for expecting and new parents to twins. I’m your host Christine Stewart-Fitzgerald.

Have you heard about the Twin Talks Club? Our members get bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly Twin Talks Newsletter and learn about the latest episodes available.

Another way for you to stay connected is by downloading our free Twin Talks app available on the Android and iTunes Marketplace. Are you interested in being involved with our show? We have a new Virtual Panellists Program. I’m going to turn to Shelly, our producer to tell you about it.

SHELLY STEELY: For those of you that are following along at home, there are number of new ways to keep connected with Twin Talks. You can follow us on Facebook or on Twitter. If you’re following along the conversation on Twitter from home, just use hash tag #TwinTalksVP to become a virtual panellist and participate in our discussions live.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Before we get started, we’ve got some panellists in our studio today. So, let’s go around and learn a little bit about you. Tell us about your twins and how old they are, if they’ve spend any time in the NICU. So, let’s see. Let’s start with Carolyn.

CAROLYN BENTLEY: Hi, my name is Carolyn. I’m 31 years old and I’m a stay-at-home mom to two beautiful girls – Lauren and Kyla. They are fraternal twins, 19 months old. They were born at 31 weeks, 5 days gestation. So, they spent about six weeks each in the NICU and are now, happy healthy rambunctious toddlers.

CHRISTINE STEWART-FITZGERALD: Awesome. Okay and we got Shelly, our producer and panellist.

SHELLY STEELY: Hi, Shelly. I’m 30. I’m a high school history teacher and I have identical twin boys who are almost 15 months now – Greyson and Sawyer. I was lucky enough to have them at 37 weeks. So, we just [inaudible] standard five days in the hospital and then they went home with me.

CHRISTINE STEWART-FITZGERALD: Awesome.

SUNNY GAULT: I’m Sunny and I’ve got two little boys at home already. One is three years old and one is 17 months old. I’m pregnant with twin identical girls. I’m 31 weeks right now. I’m hoping to not to go to the NICU, fingers crossed. I do have a C Section that is scheduled for one in about 38 weeks.

So, we’re kind of pushing the envelope a little bit. But, in my head I have to have a date that’s later or I feel like they’re bound to come early. So, I’m trying to hold off as long as I can.

CHRISTINE STEWART-FITZGERALD: Hold on.

SUNNY GAULT: Yes, exactly hold on to them.

MOLLY RIFFEL: My name is Molly Riffel. I’m 32. I’m a teacher but a stay-at-home mom currently. I have two girls. I have a two and half year old and a six month old. I don’t have twins but my six month old spent 80 days in the NICU. So, I have a little bit of experience there.

CHRISTINE STEWART-FITZGERALD: As your host, my twins are four years old. They’re identical girls. I did have an experience with the NICU but is very short. I ended up having a C Section. My first girl Baby A came out, she was fine. The second girl has just a little bit of breathing problems. She was in the NICU thankfully, just for a few hours. I’m grateful that it was there and thankfully, we didn’t have to spend a lot of time there.

Today, we’re talking about: “Inside the NICU, what to expect.” But, before we talk about the NICU; we’re setting here with Dr. Sean Daneshmand and here’s the founder of Miracle Babies.

DR. SEAN DANESHMAND: Thank you so much Christine. This is a topic obviously I’d love talking about. Miracle Babies is a Non Profit Organization. We are about developing a healthier society. We believed the pre-requisites for having healthy children is health in the mind and body, respect and hope.

Remember that over half a million babies are born prematurely every year here in the US. About three to four percent of all pregnancies have congenital abnormalities. It equates to about a 130,000 babies born every year that may require surgery. So, many of these angels end up in the NICU and how we started with Miracle Babies is that: “We found that many parents can’t get to the NICU or the Neonatal Intensive Care Unit because not every hospital can take care of these precious angels.”

So, parents have to drive – parents have to get child care, parents have to put food on the table. Remember: “This is a life altering moment for many people.” All of the sudden they hear: “What? My baby has this or my baby’s being born at 24 weeks, 25 weeks, and 26 weeks.” Their life is completely turned upside down. They have to live for months sometimes in the NICU. They have to come in every day and life doesn’t stop. Everything goes on.

So, what we started doing is we raise money for families so that they can be there with their children to provide breast milk to their children, to touch their children, hold their children if they can and just that’s makes intuitive sense. Every mom should be able to be with their sick child.

Now, on our preventative part; we teamed up with the YMCA. We’re addressing health and nutrition so environmental factors. We believed that children are programmed and either the most critical time that a child’s brain development and really in regards to even organic disease, we believe happens in [inaudible] the immediate post natal period.

So, if we can address health and nutrition; really address this with our women, children are going to be healthier. So, a lot of the focus is on children. Our focus is children but we feel that women should be the target. If women have all the tools they need. If women are healthy, mentally, physically – they will pass that on to their children.

These genes are programmed a term called: “Epigenetic or certain genes are turned on and off; it will alter the way they are.” Christine, remember that: “Two to three percent of all pregnancies end up with in that critical time of premature that we talked about which was less than 32 weeks; majority are after 32 weeks.

So, if you reduce some of the co-morbidities associated with unhealthy habits, you will have hopefully less babies that are – that we as obstetricians or midwives and care takers deliver earlier. I really think we’re going to have a huge impact to society.

CHRISTINE STEWART-FITZGERALD: I have to say Dr. Daneshmand; we really love your organization. So, we have a special club – The Twin Talks Club; we’ve decided we’d like to donate part of the proceeds from the club membership to Miracle Babies in support of that mission.

DR. SEAN DANESHMAND: Thank you so much Christine.

CHRISTINE STEWART-FITZGERALD: Thank you.

DR. SEAN DANESHMAND: That means the world to us. That means the world to our families and it just tells us about your involvement in the community not only in regards to education but social services and health and nutrition – so, I really appreciate it.

CHRISTINE STEWART-FITZGERALD: Well, thank you.

DR. SEAN DANESHMAND: Thank you.

CHRISTINE STEWART-FITZGERALD: So, today’s topic is: “Inside the NICU, what to expect.” We’re talking with Nancy Meyers. She is a neonatal nurse and a manager of the Tri City Medical Centre NICU. She’s been helping twin newborns and their families for I think I heard 36 years.

NANCY MEYERS: That’s correct, 36 years.

CHRISTINE STEWART-FITZGERALD: That’s amazing. So, I imagined you’ve seen it all.

NANCY MEYERS: Seen it all and seen the world of neonatal nursing and the care that we can give babies in the NICU particularly pre-term babies just to advance so tremendously and it’s constantly an evolving knowledge base and technology. We’re never stagnant.

We’re always learning more and more about how those preterm babies developed and what they need from us in the world of NICU to help sustain a normal development outside the uterus. It’s an exciting field.

CHRISTINE STEWART-FITZGERALD: I imagined: “You’ve got so many more success stories now than you would have 30 plus years ago.”

NANCY MEYERS: Absolutely, just with the development of liquid called: “Surfactant” which helps mature lungs in preterm infant, the ability to help babies born early and early has just constantly evolved and improved.

CHRISTINE STEWART-FITZGERALD: When we talked about this type of care, I think statistically, the new-borns’ spending time in the NICU are the minority. How likely are newborn twins going to spend time in the NICU?

NANCY MEYERS: Typically, we see about one in five twin births that need some sort of level of care in the NICU for a variety of reasons. It could be from prematurity itself, infections – if twins born between 35 and 37 weeks can still experience challenges with feeding and jaundice, some breathing problems to some extent.

CHRISTINE STEWART-FITZGERALD: Is there a typical stay for twins that are not preterm or for preterm twins, what’s an average thing?

NANCY MEYERS: For babies born preterm, typically a lot of it depends on how early they were and how many challenges they have during their NICU stay in regards to breathing concerns, infections, feeding concerns. We used to say in the NICU and tell parents that: “Kind of expect your baby to go home in an around, their dues date.”

We’ve kind of move away from that because we think that’s an expectation for parents for either being too early or too late in working around that date can be a disappointment for parents” if those babies don’t go home in that time. So, we look at all the things and encourage parents to know that when they’re baby no longer needs extra heat, maintain their own temperature in an open crib that they are taking everything by mouth and or breast.

They have no signs of infections. They don’t have any more challenges with breathing or forgetting to breathe which preterm infants do very well. Then, we start to look at already to go home. A lot of times that is before their due date and you were from 35 weeks what we call it gestational age up to in an around their due date.

However, some depending on the course of the babies in the NICU; it may extend beyond that. It just really, really depends on each baby. They write their own chapter, we don’t.

CHRISTINE STEWART-FITZGERALD: For our panellists here today who delivered preterm when did your twins get to go home?

CAROLYN BENTLEY: So, my twins were born at 31 weeks, five days after I have been on hospital bed rest for a few weeks. So, we’ve gotten multiple courses of steroids to help with their lung development and they ended up staying about six and six and a half weeks each in the NICU. They came home, one came home on a Monday, the other came home on the following Friday.

We have been told by the doctors to expect plus or minus two weeks from their due date. But, the interesting thing was: “There is no mentioned of going home, getting ready.” It was just meeting these milestones. They can maintain their body temperature; they’re taking some of their feeds like early in; just focusing on those milestones and hitting them.

All of a sudden, it was Friday and they’re like: “I think your kids can come home on Monday.” We were like: “Yeah.” Of course, with twins you do face the issue I don’t know if it’s a blessing or a curse that they don’t always come home on the same day.

For us, it was nice in some aspects to adjust having one child at home. Then of course we thought: “We got this.” You throw the second one in.

CHRISTINE STEWART-FITZGERALD: Okay.

CAROLYN BENTLEY: That was our experience about six weeks. So, they came home about two weeks before their due date.

CHRISTINE STEWART-FITZGERALD: That’s great and so, Molly so we have you here, tell us about your experience.

MOLLY RIFFEL: Well, my daughter was born – she was seven weeks early. She was born with a heart commission and Down Syndrome. So, she was originally born we kept being told: “She just needed to eat.” That all she needed to do. After a while, she wasn’t eating and she wasn’t being able to take it in on her own and they just kept saying: “She’ll get there.”

They weren’t focusing on the fact that she had a heart condition, so for us – it was they told us: “By your due date, you’ll be home.” It was kind of four weeks after due date, we finally got to go home. Well, it’s hard because in the beginning they told us: “A couple of weeks be here a couple of weeks the most.” Then it was: “Wait in your due date.” Then it was: “Well, maybe it’s going to be longer.” So, it was very nice if they didn’t say due dates.

CHRISTINE STEWART-FITZGERALD: So, the parents were really needed to have open minds and be flexible and not be focused on particular time frame either; be set up for disappointment. Be kind of caught off guard and wait, I’ve got babies coming home now.

SHELLY STEELY: It’s nice to focus on those small milestones that they need to hit before they can come home instead of focusing on that long far off goal because thinking about driving to the hospital, once a day, twice a day for weeks on just it’s exhausting.

CHRISTINE STEWART-FITZGERALD: I can imagine, planning for that. Well, switching gears – going back to the NICU itself. So, Nancy can you tell us about the different kinds of NICUs. I’ve heard there are different levels of NICUs. They’re kind of 1, 2, and 3 what this that, actually mean?

NANCY MEYERS: That is correct. The American Academy of Paediatrics defines a level of NICUs based on the type of babies any particular, you’ll notice you’ll be able to take care of. That’s including how premature of babies are able to take care of. What kind of staff is available to care for those babies?

So, having in house 24/7 neonatology, a physician coverage – the level of training that all of the multi-disciplinary team including the nurses have the equipment that is available to care of babies in any particular NICU. So, a Level One is truly a unit that is going to take care of that normal newborn or maybe a baby that is having some challenges in those first four to six hours transitioning from birth.

Then, from there it does go up to an including Level Four. That’s units like our own ready children’s hospital in the San Diego area who cares for the sickest baby. They’re able to do the cardiac surgery; the baby’s that require the highest of level respiratory support.

We at Tri City – a level three meaning we keep babies that are born as early as 26 weeks. We have the training, the staff and the technology to do that. We always partner with either UCST or Radio Children’s Hospital for babies that are in need of surgery or the cardiac babies.

Babies requiring unique sort of sub especially support that are regional centres can provide in these areas.

CHRISTINE STEWART-FITZGERALD: So, its sounds like for many of our listeners cross the country and if they’re local hospital has a NICU a one or two for some reason they find that they need to find a higher level of care – so, that means that their baby might be transferred to another institution?

NANCY MEYERS: That’s correct. That just compounds the experience at the parents are now having with having a baby in the NICU not as only the baby in the NICU but now, it’s in a NICU much further away from a recovering mother, home and family support. So, that’s just an additional challenge for that family.

CHRISTINE STEWART-FITZGERALD: So, can you tell us about some of the equipment that we might see because I know for someone walking into it for the first time, it might be a little bit overwhelming. What do we see and what is it used for?

NANCY MEYERS: It’s not a little bit overwhelming, it’s very overwhelming. I think all over moms that are here can attest to that. We’re a unit that relies very heavily on technology. Our babies can’t speak to us in words. So, we rely on not only on our own knowledge and education and training but that of equipment as well to provide an additional inside as to what’s going on with that baby.

So, there are cardiac monitors that are all the babies were on. There are various types of isolets that provide not only the warmth environment that particular preterm babies need but also a developmentally appropriate environment to keep them away from the noise and the light that is so impacting to their developing brains.

We rely on IV pumps to deliver fluids and medication and keep in mind that every piece of technology we have, has an alarm with it that helps tell us if that baby needs an intervention or something might be going on that we need to be alerted to right away. So, you walk into an environment with strange equipments, lots of alarms, lots of unit sounds that you’ve never exposed to and when you throw the jargon that we use on top of that, it’s very overwhelming for parents.

We at Tri City immediately try to help educate to all of that means. What’s it doing for their baby and try to help the parents focus on the baby.

CHRISTINE STEWART-FITZGERALD: Definitely, so from our panellists; what was your experience? I mean walking in to the NICU for the first time, what were your thoughts?

CAROLYN BENTLEY: Since I’ve been hospitalized before hand, we chose to take a tour and we got to meet with some of the NICU doctors and nurses and kind of get a feel for these are – at UCS, we were at UCST.

The different zones of the NICU and they purposely did not take us through the area were the sickest babies were because that doesn’t make you feel any better. Just kind of got us familiar with some of the different machines and what would happen – your babies are going to be born and they’re going to be worked on here. They’re going to come here. So, we had some understanding of what was going to happen before we went into it.

So, the first time you go down there, in the heart rate monitors and the oxygen monitors and temperature monitors and IV’s everywhere. It’s very difficult to just have those like newborn snuggle moments with your baby, with all of these cords everywhere. We were lucky that at least one of my daughters we could hold right away.

That’s another complication that people have is not being able to have that contact with the baby as soon it’s born in the NICU. But you slowly get used to what all of the beeping means and it does help learning what everything is and then focusing on not just sitting there looking at the monitor, scanning their heart rate and everything but just focusing on how does the baby feel, do you feel them breathing? Do you feel them relaxing and doing things like that really helps a lot.

MOLLY RIFFEL: We didn’t actually get to see the NICU before we had our daughter because we were told that she would a regular birth and no complications, no problems and so, when she were told that she was in the NICU and I first went down there – I think she was four hours after I had her. It was a shock.

In the NICU, wherein each child had their own individual room but to go in and hear all of the noises right away and see your child hooked up to everything was just heartbreaking and then, seeing all the other babies who were smaller and more than need that it’s very traumatic.

It’s very scary, the noises still being in the hospital. The noises are just – give your heart’s rate rising. I know that noise. It’s definitely a tough thing to experience.

CHRISTINE STEWART-FITZGERALD: I guess also just seeing all the people going around to working on the babies, what does that mean? So, speaking of all the caregivers in the NICU; I know that there are a lot of different people that are giving care with different roles. Who are they and what are they doing?

NANCY MEYERS: There’s a tremendous amount of health care providers that bring components to the care of babies in the NICU. We always say that it takes a village to take care of babies in the NICU. There’s always the neonatologist who is a paediatrician who has been trained to care for just the new born and the sick new born.

So, there are specialists and that’s what they focus on. There’s neonatal train, NICU trained nurses who go through a tremendous amount of specially training; how to care for a very unique population of patients. Respiratory therapist who are trained in the care of the neonate social worker because this is not just about the baby; this is a family event, this is a family crisis.

So, social workers are hugely important in our team to assure that the family’s have everything they need whether it’s a place to say, the Ronald McDonald House whether it’s transportation and how does the rest of the family, siblings etcetera coping at home.

We also have occupation and physical therapists who work with the babies that under unique needs whether it’s a preterm baby meeting special positioning in bed or feeding is a huge milestone as we talked about for those babies going home.

So, that’s a very big focus once that baby is no longer critically ill, it’s gotten pass their breathing, their infections and all those things that they can encounter then we settle down to teach them how to eat. It can be a very slow phase, patient, rocking process.

But, our goal is always to: “Move those babies to hopefully into exclusively breastfeeding before they go home” and so, we rely of very heavily on our occupational therapists to help us through that.

Last but not the least our lactation specialists with helping with that all important as we call it Liquid Gold that breast milk and establishment of that and then establishment of breastfeeding.

CHRISTINE STEWART-FITZGERALD: That’s great. When we come back, we’re going to talk about: “How the twin moms can provide breast milk to their babies in the NICU with the help of those lactation consultants.”

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Welcome back today, we’re talking about: “Inside the NICU, what to expect with Nancy Meyers.” Our discussion continues as we look at how moms can provide breast milk to their twin babies and how parents can bond with their newborns.

So, you had mentioned that in the NICU; you’ve got occupational therapists and also lactation consultants on hand to help the babies learn how to feed and getting the right position and take it in; while the lactation consultants to help the moms.

So, how is this made possible? I think: “Breastfeeding, in itself for a full term baby, it can be a challenge. So, how is this even possible in the NICU?

NANCY MEYERS: Breast milk production and breastfeeding in the NICU is a whole new challenge to our moms; just experiencing a lot of times a C Section and we know that it can affect the breast milk production and then the emotional roller coaster of having a baby in the NICU.

We have a goal of making sure our moms get a breast pump within two hours of delivery if they’re able physically able to start the pumping. Our lactation consultant actually rounds on our [inaudible] moms and they see or watch videos of how to be effective breastfeeding in the NICU environment.

So, it really starts pre-delivery for us. Then, as moms who are able to come to the NICU, both the nurses and the lactation consultants encourages them in the pumping and making sure that they understand the importance of it. Breast milk is medicine to our babies and it’s so important.

Right from the beginning, even babies that are on ventilators that we use it for oral care because we know that there are so many benefits to those babies for that colostrums and that breast milk. As we moved into actually being able to encourage the breastfeeding experience between mom and baby; we start evaluating babies as early as 32 weeks gestation, are they ready to start getting to know that breast and what that whole experience is for them.

It begins with skin to skin. Even with twins, as babies are physically stable enough, we have them skin to skin together with mom. They were in [inaudible 00:25:41] together and they really like that closeness as well as starting to encourage that the handling of the babies together so that mom eventually can breastfeed those twins together.

We usually start with one because it can be just a physical management of

CHRISTINE STEWART-FITZGERALD: Of balancing act.

NANCY MEYERS: A true balancing act but it can be very successful. It just takes a tremendous amount of encouragement and support of that mom that she can do it and helping her with all of the challenges along the way that she may encounter with having a baby or babies in the NICU.

CHRISTINE STEWART-FITZGERALD: That’s so great that you’re providing that support from the Get-go.

NANCY MEYERS: Absolutely.

CHRISTINE STEWART-FITZGERALD: It’s a challenge but to have that to know that it’s possible. Even if they’re not nursing directly that they can breastfeed and lead up to that. For our panellists, tell me were you able to do breastfeed?

CAROLYN BENTLEY: Yes, I actually breastfeed my twins for about 14 months and they being early obviously couldn’t breastfeed them right away but as soon as I got back up to my room about four hours after they were born, someone showed up with a breast pump and even though it was 2:00 in the morning; here you go.

From that, it took me about five days of pumping for 15 minutes every three hours before my milk came in. Of course, those first couple of drops you get; you like rush them down to the NICU and they’re like: “They just pretend that they can give it to you but it’s not really till they came out.” But, you’re just happy about it.

You start looking and eventually I was able to provide enough breast milk for my girls to be fed with. Slowly, they start to get bit by bottle. We started putting them to the breast prior a week or two after they were born. They had some trouble with jaundice and other things that they weren’t actually getting any oral feeds for a while.

One of my girls took it right away actually the smaller one and just rooted around found what she wanted and went for it.

CHRISTINE STEWART-FITZGERALD: That’s awesome.

CAROLYN BENTLEY: You know there are limits. They’re so small; you can only let them try to breastfeed for so long at each session. For a long time, we just limited it to once per day so they wouldn’t burn more energy than they were taking in.

But, constant pumping and then making sure to get any rest you possibly can, eating enough, drinking enough. The nurses in the NICU are great. There were pumps littered everywhere. So, you could just sit in front and look at your babies while you’re pumping which helped a lot.

Slowly, once they were home; we transitioned in increasing the number of breastfeeding’s per day. Probably when they were have been home for about a half and a month – so they were three and a half months old, I was able to start exclusively tandem breastfeeding which got a lot easier getting rid of the pump.

CHRISTINE STEWART-FITZGERALD: Did you do breastfeeding?

MOLLY RIFFEL: I was in the beginning. My daughter latched on fine. But, in our NICU – we were encouraged to bottle feed because they want to keep track of how much she was getting. So, I tried to nurse her at least once a day. They didn’t want to do the pre-imposed weight because they said: “It wasn’t accurate.”

So, I adapt for her as much as I could and once we got home, I offered it to her all the time. She can’t actually eat. She’s a biter. She can’t actually suck but she knows it’s there so we’re working on it. But, the NICU it was hard to try and convince our nurses that we want to try breastfeeding.

Okay, you can only do it for five minutes. She’s not getting anything. It’s not going to help. So, we founded a little bit of a battle for us.

CHRISTINE STEWART-FITZGERALD: Interesting.

SHELLY STEELY: We had to limit ours to like 30 minutes of trying but yes. It was important that skin-to-skin too. My husband and I both, you come in, what outfits we have, just take your shirt off and hold him up to your skin.

It helps with their temperature regulation and just the warmth and feeling your heartbeat and stuff. It was a good experience.

CHRISTINE STEWART-FITZGERALD: Definitely.

NANCY MEYERS: Skin-to-skin has so many physical and physiological for both mom and baby and dad too. If dad wants to experience it as well; we know that babies stay warmer, easier and burn those calories doing skin-to-skin.

Moms’ body temperature will adjust to whatever the baby needs. It does help moms’ milk production. It does help the endorphins to help generate that let-down. A lot of times, we encourage mom to pump while she’s doing skin-to-skin. So, even though the baby is not ready to even [inaudible] feed or even Gavage feed; feeding through a tube into their tummy.

We can place the tiniest of babies even on ventilators with all those lines and cables that she talked about. We want those babies doing skin-to-skin for so many reasons. A lot of times, they will stay on mom’s chest for two, three hours and the smallest baby is tolerating. That’s absolute best place for them to be.

CHRISTINE STEWART-FITZGERALD: Parents are the main family care givers, is there anyone else allowed in the NICU. If there are older siblings, can they come in? What about grand parents?

NANCY MEYERS: It really varies from NICU to NICU what their visitation if you will policies. We don’t consider parent’s visitors. There are partners and the carer in the recovery of their baby. Typically, most NICUs are cautious of how young of a child though let it in because of the risk of the colds and flu etcetera – that kids’ going to acquire and bring with them.

We certainly encouraged any older family members, grandparents, aunts and uncles to help support the parents at the bed side. A lot of the times, that can be limited in number just because it isn’t ICU environment and again, the noise and we’ve got lots of things, small things going on.

Private occupancy can help minimize that but if it’s an open day kind of NICU like a Tri City is, you may see only two at the bedside.

CHRISTINE STEWART-FITZGERALD: So, for the parents that are visiting – what are some of the rules and sort of the guidelines, what can they expect in terms of visiting hours; the time they spent there, the type of interaction?

NANCY MEYERS: Again, kind of NICU is unique. We encourage parents to be there as much as they possibly can with mom recovering with their siblings at home 24/7. It doesn’t mean necessarily mean be there 24 hours a day. But, our doors are always open so that anytime any time of the day and night, they want to come and be with that baby; help care for that baby, we’re there. The baby’s there and we openly encouraged them to do that.

Again, it might hit the beginning very minimal what they can do just touch time. Maybe some skin-to-skin but we encourage our parents and support our parents in gradually is that baby gets better to become more actively engaged in the care of that baby from diaper changing to anything and everything that their baby’s need from them as a parent.

CHRISTINE STEWART-FITZGERALD: Well, thanks so much Nancy for joining us today. For more information about: “Inside the NICU, what to expect” or for more information about any of our experts or panellists, visit the episode page on our website. This conversation continues for members of our Twin Talks Club.

After the show, Miss Meyers will tell us about: “How parents of newly admitted new babies in the NICU can keep their sanity.” So, for more information about the Twin Talks Club, visit our website: TwinTalks.com.

SHELLY STEELY: Today on our Annoying Comments People Make to Twin Moms, we have Jamie in San Francisco. Jamie says:

“I have fraternal boy-girl twins. Yesterday, I almost smack this lady for being so ignorant. She was telling her son while pointing at my babies – Look son, that’s our future right there. Those are cute boys. Are they identical?” I said: “No, they are a boy and a girl and not two boys.”

Not to mention, my daughter was in a pink dress. After I told this woman that it’s a boy and a girl, she had the nerve to say: “Well, she would make a cute boy.” Really? I took everything I had not to call her the names that I wanted too.” -Jamie

[Theme Music]

CHRISTINE STEWART-FITZGERALD: So, that wraps up our show for today. We appreciate you listening to Twin Talks. Join in on the discussion by posting your comments on the Twin Talks Facebook page or call in our voice mail at 619-866-4775.

Don’t forget to check our sister shows:

• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers an online support group for the new parents.

Next week, we’re going to get: “Tips on creating a routine for your new born twins.” This is Twin Talks, parenting times two.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or an organization interested in our network of our shows through a cobranded podcasts, visit www.NewMommyMedia.com .

[00:35:47]
[End of Audio]

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Episode Transcript

Twin Talks
Inside The NICU: What To Expect

[00:00:00]

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

NANCY MEYERS: Well most new born twins don’t need to spend time in the NICU. It’s always helpful for expectant parents to be familiar with it in the event that it is needed. It’s nice to have questions that answer the head of time like: “What are all those machines? Can I even hold my baby?”

I’m Nancy Meyers, a neonatal nurse and manager of Tri City Medical Centre talking today about: “The NICU, what to expect?” This is Twin Talks Episode Number 5.

[Theme Music/Intro]

CHRISTINE STEWART-FITZGERALD: If you’re pregnant with twins or you’re an experienced twin parent, odds are you have heard it all before. Now, it’s time to hear from the experts. This is Twin Talks, parenting times two.

Welcome to Twin Talks broadcasting from the Birth Education Centre of San Diego. Twin Talks is your weekly online on-the-go support group for expecting and new parents to twins. I’m your host Christine Stewart-Fitzgerald.

Have you heard about the Twin Talks Club? Our members get bonus content after each new show plus special giveaways and discounts. Subscribe to our monthly Twin Talks Newsletter and learn about the latest episodes available.

Another way for you to stay connected is by downloading our free Twin Talks app available on the Android and iTunes Marketplace. Are you interested in being involved with our show? We have a new Virtual Panellists Program. I’m going to turn to Shelly, our producer to tell you about it.

SHELLY STEELY: For those of you that are following along at home, there are number of new ways to keep connected with Twin Talks. You can follow us on Facebook or on Twitter. If you’re following along the conversation on Twitter from home, just use hash tag #TwinTalksVP to become a virtual panellist and participate in our discussions live.

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Before we get started, we’ve got some panellists in our studio today. So, let’s go around and learn a little bit about you. Tell us about your twins and how old they are, if they’ve spend any time in the NICU. So, let’s see. Let’s start with Carolyn.

CAROLYN BENTLEY: Hi, my name is Carolyn. I’m 31 years old and I’m a stay-at-home mom to two beautiful girls – Lauren and Kyla. They are fraternal twins, 19 months old. They were born at 31 weeks, 5 days gestation. So, they spent about six weeks each in the NICU and are now, happy healthy rambunctious toddlers.

CHRISTINE STEWART-FITZGERALD: Awesome. Okay and we got Shelly, our producer and panellist.

SHELLY STEELY: Hi, Shelly. I’m 30. I’m a high school history teacher and I have identical twin boys who are almost 15 months now – Greyson and Sawyer. I was lucky enough to have them at 37 weeks. So, we just [inaudible] standard five days in the hospital and then they went home with me.

CHRISTINE STEWART-FITZGERALD: Awesome.

SUNNY GAULT: I’m Sunny and I’ve got two little boys at home already. One is three years old and one is 17 months old. I’m pregnant with twin identical girls. I’m 31 weeks right now. I’m hoping to not to go to the NICU, fingers crossed. I do have a C Section that is scheduled for one in about 38 weeks.

So, we’re kind of pushing the envelope a little bit. But, in my head I have to have a date that’s later or I feel like they’re bound to come early. So, I’m trying to hold off as long as I can.

CHRISTINE STEWART-FITZGERALD: Hold on.

SUNNY GAULT: Yes, exactly hold on to them.

MOLLY RIFFEL: My name is Molly Riffel. I’m 32. I’m a teacher but a stay-at-home mom currently. I have two girls. I have a two and half year old and a six month old. I don’t have twins but my six month old spent 80 days in the NICU. So, I have a little bit of experience there.

CHRISTINE STEWART-FITZGERALD: As your host, my twins are four years old. They’re identical girls. I did have an experience with the NICU but is very short. I ended up having a C Section. My first girl Baby A came out, she was fine. The second girl has just a little bit of breathing problems. She was in the NICU thankfully, just for a few hours. I’m grateful that it was there and thankfully, we didn’t have to spend a lot of time there.

Today, we’re talking about: “Inside the NICU, what to expect.” But, before we talk about the NICU; we’re setting here with Dr. Sean Daneshmand and here’s the founder of Miracle Babies.

DR. SEAN DANESHMAND: Thank you so much Christine. This is a topic obviously I’d love talking about. Miracle Babies is a Non Profit Organization. We are about developing a healthier society. We believed the pre-requisites for having healthy children is health in the mind and body, respect and hope.

Remember that over half a million babies are born prematurely every year here in the US. About three to four percent of all pregnancies have congenital abnormalities. It equates to about a 130,000 babies born every year that may require surgery. So, many of these angels end up in the NICU and how we started with Miracle Babies is that: “We found that many parents can’t get to the NICU or the Neonatal Intensive Care Unit because not every hospital can take care of these precious angels.”

So, parents have to drive – parents have to get child care, parents have to put food on the table. Remember: “This is a life altering moment for many people.” All of the sudden they hear: “What? My baby has this or my baby’s being born at 24 weeks, 25 weeks, and 26 weeks.” Their life is completely turned upside down. They have to live for months sometimes in the NICU. They have to come in every day and life doesn’t stop. Everything goes on.

So, what we started doing is we raise money for families so that they can be there with their children to provide breast milk to their children, to touch their children, hold their children if they can and just that’s makes intuitive sense. Every mom should be able to be with their sick child.

Now, on our preventative part; we teamed up with the YMCA. We’re addressing health and nutrition so environmental factors. We believed that children are programmed and either the most critical time that a child’s brain development and really in regards to even organic disease, we believe happens in [inaudible] the immediate post natal period.

So, if we can address health and nutrition; really address this with our women, children are going to be healthier. So, a lot of the focus is on children. Our focus is children but we feel that women should be the target. If women have all the tools they need. If women are healthy, mentally, physically – they will pass that on to their children.

These genes are programmed a term called: “Epigenetic or certain genes are turned on and off; it will alter the way they are.” Christine, remember that: “Two to three percent of all pregnancies end up with in that critical time of premature that we talked about which was less than 32 weeks; majority are after 32 weeks.

So, if you reduce some of the co-morbidities associated with unhealthy habits, you will have hopefully less babies that are – that we as obstetricians or midwives and care takers deliver earlier. I really think we’re going to have a huge impact to society.

CHRISTINE STEWART-FITZGERALD: I have to say Dr. Daneshmand; we really love your organization. So, we have a special club – The Twin Talks Club; we’ve decided we’d like to donate part of the proceeds from the club membership to Miracle Babies in support of that mission.

DR. SEAN DANESHMAND: Thank you so much Christine.

CHRISTINE STEWART-FITZGERALD: Thank you.

DR. SEAN DANESHMAND: That means the world to us. That means the world to our families and it just tells us about your involvement in the community not only in regards to education but social services and health and nutrition – so, I really appreciate it.

CHRISTINE STEWART-FITZGERALD: Well, thank you.

DR. SEAN DANESHMAND: Thank you.

CHRISTINE STEWART-FITZGERALD: So, today’s topic is: “Inside the NICU, what to expect.” We’re talking with Nancy Meyers. She is a neonatal nurse and a manager of the Tri City Medical Centre NICU. She’s been helping twin newborns and their families for I think I heard 36 years.

NANCY MEYERS: That’s correct, 36 years.

CHRISTINE STEWART-FITZGERALD: That’s amazing. So, I imagined you’ve seen it all.

NANCY MEYERS: Seen it all and seen the world of neonatal nursing and the care that we can give babies in the NICU particularly pre-term babies just to advance so tremendously and it’s constantly an evolving knowledge base and technology. We’re never stagnant.

We’re always learning more and more about how those preterm babies developed and what they need from us in the world of NICU to help sustain a normal development outside the uterus. It’s an exciting field.

CHRISTINE STEWART-FITZGERALD: I imagined: “You’ve got so many more success stories now than you would have 30 plus years ago.”

NANCY MEYERS: Absolutely, just with the development of liquid called: “Surfactant” which helps mature lungs in preterm infant, the ability to help babies born early and early has just constantly evolved and improved.

CHRISTINE STEWART-FITZGERALD: When we talked about this type of care, I think statistically, the new-borns’ spending time in the NICU are the minority. How likely are newborn twins going to spend time in the NICU?

NANCY MEYERS: Typically, we see about one in five twin births that need some sort of level of care in the NICU for a variety of reasons. It could be from prematurity itself, infections – if twins born between 35 and 37 weeks can still experience challenges with feeding and jaundice, some breathing problems to some extent.

CHRISTINE STEWART-FITZGERALD: Is there a typical stay for twins that are not preterm or for preterm twins, what’s an average thing?

NANCY MEYERS: For babies born preterm, typically a lot of it depends on how early they were and how many challenges they have during their NICU stay in regards to breathing concerns, infections, feeding concerns. We used to say in the NICU and tell parents that: “Kind of expect your baby to go home in an around, their dues date.”

We’ve kind of move away from that because we think that’s an expectation for parents for either being too early or too late in working around that date can be a disappointment for parents” if those babies don’t go home in that time. So, we look at all the things and encourage parents to know that when they’re baby no longer needs extra heat, maintain their own temperature in an open crib that they are taking everything by mouth and or breast.

They have no signs of infections. They don’t have any more challenges with breathing or forgetting to breathe which preterm infants do very well. Then, we start to look at already to go home. A lot of times that is before their due date and you were from 35 weeks what we call it gestational age up to in an around their due date.

However, some depending on the course of the babies in the NICU; it may extend beyond that. It just really, really depends on each baby. They write their own chapter, we don’t.

CHRISTINE STEWART-FITZGERALD: For our panellists here today who delivered preterm when did your twins get to go home?

CAROLYN BENTLEY: So, my twins were born at 31 weeks, five days after I have been on hospital bed rest for a few weeks. So, we’ve gotten multiple courses of steroids to help with their lung development and they ended up staying about six and six and a half weeks each in the NICU. They came home, one came home on a Monday, the other came home on the following Friday.

We have been told by the doctors to expect plus or minus two weeks from their due date. But, the interesting thing was: “There is no mentioned of going home, getting ready.” It was just meeting these milestones. They can maintain their body temperature; they’re taking some of their feeds like early in; just focusing on those milestones and hitting them.

All of a sudden, it was Friday and they’re like: “I think your kids can come home on Monday.” We were like: “Yeah.” Of course, with twins you do face the issue I don’t know if it’s a blessing or a curse that they don’t always come home on the same day.

For us, it was nice in some aspects to adjust having one child at home. Then of course we thought: “We got this.” You throw the second one in.

CHRISTINE STEWART-FITZGERALD: Okay.

CAROLYN BENTLEY: That was our experience about six weeks. So, they came home about two weeks before their due date.

CHRISTINE STEWART-FITZGERALD: That’s great and so, Molly so we have you here, tell us about your experience.

MOLLY RIFFEL: Well, my daughter was born – she was seven weeks early. She was born with a heart commission and Down Syndrome. So, she was originally born we kept being told: “She just needed to eat.” That all she needed to do. After a while, she wasn’t eating and she wasn’t being able to take it in on her own and they just kept saying: “She’ll get there.”

They weren’t focusing on the fact that she had a heart condition, so for us – it was they told us: “By your due date, you’ll be home.” It was kind of four weeks after due date, we finally got to go home. Well, it’s hard because in the beginning they told us: “A couple of weeks be here a couple of weeks the most.” Then it was: “Wait in your due date.” Then it was: “Well, maybe it’s going to be longer.” So, it was very nice if they didn’t say due dates.

CHRISTINE STEWART-FITZGERALD: So, the parents were really needed to have open minds and be flexible and not be focused on particular time frame either; be set up for disappointment. Be kind of caught off guard and wait, I’ve got babies coming home now.

SHELLY STEELY: It’s nice to focus on those small milestones that they need to hit before they can come home instead of focusing on that long far off goal because thinking about driving to the hospital, once a day, twice a day for weeks on just it’s exhausting.

CHRISTINE STEWART-FITZGERALD: I can imagine, planning for that. Well, switching gears – going back to the NICU itself. So, Nancy can you tell us about the different kinds of NICUs. I’ve heard there are different levels of NICUs. They’re kind of 1, 2, and 3 what this that, actually mean?

NANCY MEYERS: That is correct. The American Academy of Paediatrics defines a level of NICUs based on the type of babies any particular, you’ll notice you’ll be able to take care of. That’s including how premature of babies are able to take care of. What kind of staff is available to care for those babies?

So, having in house 24/7 neonatology, a physician coverage – the level of training that all of the multi-disciplinary team including the nurses have the equipment that is available to care of babies in any particular NICU. So, a Level One is truly a unit that is going to take care of that normal newborn or maybe a baby that is having some challenges in those first four to six hours transitioning from birth.

Then, from there it does go up to an including Level Four. That’s units like our own ready children’s hospital in the San Diego area who cares for the sickest baby. They’re able to do the cardiac surgery; the baby’s that require the highest of level respiratory support.

We at Tri City – a level three meaning we keep babies that are born as early as 26 weeks. We have the training, the staff and the technology to do that. We always partner with either UCST or Radio Children’s Hospital for babies that are in need of surgery or the cardiac babies.

Babies requiring unique sort of sub especially support that are regional centres can provide in these areas.

CHRISTINE STEWART-FITZGERALD: So, its sounds like for many of our listeners cross the country and if they’re local hospital has a NICU a one or two for some reason they find that they need to find a higher level of care – so, that means that their baby might be transferred to another institution?

NANCY MEYERS: That’s correct. That just compounds the experience at the parents are now having with having a baby in the NICU not as only the baby in the NICU but now, it’s in a NICU much further away from a recovering mother, home and family support. So, that’s just an additional challenge for that family.

CHRISTINE STEWART-FITZGERALD: So, can you tell us about some of the equipment that we might see because I know for someone walking into it for the first time, it might be a little bit overwhelming. What do we see and what is it used for?

NANCY MEYERS: It’s not a little bit overwhelming, it’s very overwhelming. I think all over moms that are here can attest to that. We’re a unit that relies very heavily on technology. Our babies can’t speak to us in words. So, we rely on not only on our own knowledge and education and training but that of equipment as well to provide an additional inside as to what’s going on with that baby.

So, there are cardiac monitors that are all the babies were on. There are various types of isolets that provide not only the warmth environment that particular preterm babies need but also a developmentally appropriate environment to keep them away from the noise and the light that is so impacting to their developing brains.

We rely on IV pumps to deliver fluids and medication and keep in mind that every piece of technology we have, has an alarm with it that helps tell us if that baby needs an intervention or something might be going on that we need to be alerted to right away. So, you walk into an environment with strange equipments, lots of alarms, lots of unit sounds that you’ve never exposed to and when you throw the jargon that we use on top of that, it’s very overwhelming for parents.

We at Tri City immediately try to help educate to all of that means. What’s it doing for their baby and try to help the parents focus on the baby.

CHRISTINE STEWART-FITZGERALD: Definitely, so from our panellists; what was your experience? I mean walking in to the NICU for the first time, what were your thoughts?

CAROLYN BENTLEY: Since I’ve been hospitalized before hand, we chose to take a tour and we got to meet with some of the NICU doctors and nurses and kind of get a feel for these are – at UCS, we were at UCST.

The different zones of the NICU and they purposely did not take us through the area were the sickest babies were because that doesn’t make you feel any better. Just kind of got us familiar with some of the different machines and what would happen – your babies are going to be born and they’re going to be worked on here. They’re going to come here. So, we had some understanding of what was going to happen before we went into it.

So, the first time you go down there, in the heart rate monitors and the oxygen monitors and temperature monitors and IV’s everywhere. It’s very difficult to just have those like newborn snuggle moments with your baby, with all of these cords everywhere. We were lucky that at least one of my daughters we could hold right away.

That’s another complication that people have is not being able to have that contact with the baby as soon it’s born in the NICU. But you slowly get used to what all of the beeping means and it does help learning what everything is and then focusing on not just sitting there looking at the monitor, scanning their heart rate and everything but just focusing on how does the baby feel, do you feel them breathing? Do you feel them relaxing and doing things like that really helps a lot.

MOLLY RIFFEL: We didn’t actually get to see the NICU before we had our daughter because we were told that she would a regular birth and no complications, no problems and so, when she were told that she was in the NICU and I first went down there – I think she was four hours after I had her. It was a shock.

In the NICU, wherein each child had their own individual room but to go in and hear all of the noises right away and see your child hooked up to everything was just heartbreaking and then, seeing all the other babies who were smaller and more than need that it’s very traumatic.

It’s very scary, the noises still being in the hospital. The noises are just – give your heart’s rate rising. I know that noise. It’s definitely a tough thing to experience.

CHRISTINE STEWART-FITZGERALD: I guess also just seeing all the people going around to working on the babies, what does that mean? So, speaking of all the caregivers in the NICU; I know that there are a lot of different people that are giving care with different roles. Who are they and what are they doing?

NANCY MEYERS: There’s a tremendous amount of health care providers that bring components to the care of babies in the NICU. We always say that it takes a village to take care of babies in the NICU. There’s always the neonatologist who is a paediatrician who has been trained to care for just the new born and the sick new born.

So, there are specialists and that’s what they focus on. There’s neonatal train, NICU trained nurses who go through a tremendous amount of specially training; how to care for a very unique population of patients. Respiratory therapist who are trained in the care of the neonate social worker because this is not just about the baby; this is a family event, this is a family crisis.

So, social workers are hugely important in our team to assure that the family’s have everything they need whether it’s a place to say, the Ronald McDonald House whether it’s transportation and how does the rest of the family, siblings etcetera coping at home.

We also have occupation and physical therapists who work with the babies that under unique needs whether it’s a preterm baby meeting special positioning in bed or feeding is a huge milestone as we talked about for those babies going home.

So, that’s a very big focus once that baby is no longer critically ill, it’s gotten pass their breathing, their infections and all those things that they can encounter then we settle down to teach them how to eat. It can be a very slow phase, patient, rocking process.

But, our goal is always to: “Move those babies to hopefully into exclusively breastfeeding before they go home” and so, we rely of very heavily on our occupational therapists to help us through that.

Last but not the least our lactation specialists with helping with that all important as we call it Liquid Gold that breast milk and establishment of that and then establishment of breastfeeding.

CHRISTINE STEWART-FITZGERALD: That’s great. When we come back, we’re going to talk about: “How the twin moms can provide breast milk to their babies in the NICU with the help of those lactation consultants.”

[Theme Music]

CHRISTINE STEWART-FITZGERALD: Welcome back today, we’re talking about: “Inside the NICU, what to expect with Nancy Meyers.” Our discussion continues as we look at how moms can provide breast milk to their twin babies and how parents can bond with their newborns.

So, you had mentioned that in the NICU; you’ve got occupational therapists and also lactation consultants on hand to help the babies learn how to feed and getting the right position and take it in; while the lactation consultants to help the moms.

So, how is this made possible? I think: “Breastfeeding, in itself for a full term baby, it can be a challenge. So, how is this even possible in the NICU?

NANCY MEYERS: Breast milk production and breastfeeding in the NICU is a whole new challenge to our moms; just experiencing a lot of times a C Section and we know that it can affect the breast milk production and then the emotional roller coaster of having a baby in the NICU.

We have a goal of making sure our moms get a breast pump within two hours of delivery if they’re able physically able to start the pumping. Our lactation consultant actually rounds on our [inaudible] moms and they see or watch videos of how to be effective breastfeeding in the NICU environment.

So, it really starts pre-delivery for us. Then, as moms who are able to come to the NICU, both the nurses and the lactation consultants encourages them in the pumping and making sure that they understand the importance of it. Breast milk is medicine to our babies and it’s so important.

Right from the beginning, even babies that are on ventilators that we use it for oral care because we know that there are so many benefits to those babies for that colostrums and that breast milk. As we moved into actually being able to encourage the breastfeeding experience between mom and baby; we start evaluating babies as early as 32 weeks gestation, are they ready to start getting to know that breast and what that whole experience is for them.

It begins with skin to skin. Even with twins, as babies are physically stable enough, we have them skin to skin together with mom. They were in [inaudible 00:25:41] together and they really like that closeness as well as starting to encourage that the handling of the babies together so that mom eventually can breastfeed those twins together.

We usually start with one because it can be just a physical management of

CHRISTINE STEWART-FITZGERALD: Of balancing act.

NANCY MEYERS: A true balancing act but it can be very successful. It just takes a tremendous amount of encouragement and support of that mom that she can do it and helping her with all of the challenges along the way that she may encounter with having a baby or babies in the NICU.

CHRISTINE STEWART-FITZGERALD: That’s so great that you’re providing that support from the Get-go.

NANCY MEYERS: Absolutely.

CHRISTINE STEWART-FITZGERALD: It’s a challenge but to have that to know that it’s possible. Even if they’re not nursing directly that they can breastfeed and lead up to that. For our panellists, tell me were you able to do breastfeed?

CAROLYN BENTLEY: Yes, I actually breastfeed my twins for about 14 months and they being early obviously couldn’t breastfeed them right away but as soon as I got back up to my room about four hours after they were born, someone showed up with a breast pump and even though it was 2:00 in the morning; here you go.

From that, it took me about five days of pumping for 15 minutes every three hours before my milk came in. Of course, those first couple of drops you get; you like rush them down to the NICU and they’re like: “They just pretend that they can give it to you but it’s not really till they came out.” But, you’re just happy about it.

You start looking and eventually I was able to provide enough breast milk for my girls to be fed with. Slowly, they start to get bit by bottle. We started putting them to the breast prior a week or two after they were born. They had some trouble with jaundice and other things that they weren’t actually getting any oral feeds for a while.

One of my girls took it right away actually the smaller one and just rooted around found what she wanted and went for it.

CHRISTINE STEWART-FITZGERALD: That’s awesome.

CAROLYN BENTLEY: You know there are limits. They’re so small; you can only let them try to breastfeed for so long at each session. For a long time, we just limited it to once per day so they wouldn’t burn more energy than they were taking in.

But, constant pumping and then making sure to get any rest you possibly can, eating enough, drinking enough. The nurses in the NICU are great. There were pumps littered everywhere. So, you could just sit in front and look at your babies while you’re pumping which helped a lot.

Slowly, once they were home; we transitioned in increasing the number of breastfeeding’s per day. Probably when they were have been home for about a half and a month – so they were three and a half months old, I was able to start exclusively tandem breastfeeding which got a lot easier getting rid of the pump.

CHRISTINE STEWART-FITZGERALD: Did you do breastfeeding?

MOLLY RIFFEL: I was in the beginning. My daughter latched on fine. But, in our NICU – we were encouraged to bottle feed because they want to keep track of how much she was getting. So, I tried to nurse her at least once a day. They didn’t want to do the pre-imposed weight because they said: “It wasn’t accurate.”

So, I adapt for her as much as I could and once we got home, I offered it to her all the time. She can’t actually eat. She’s a biter. She can’t actually suck but she knows it’s there so we’re working on it. But, the NICU it was hard to try and convince our nurses that we want to try breastfeeding.

Okay, you can only do it for five minutes. She’s not getting anything. It’s not going to help. So, we founded a little bit of a battle for us.

CHRISTINE STEWART-FITZGERALD: Interesting.

SHELLY STEELY: We had to limit ours to like 30 minutes of trying but yes. It was important that skin-to-skin too. My husband and I both, you come in, what outfits we have, just take your shirt off and hold him up to your skin.

It helps with their temperature regulation and just the warmth and feeling your heartbeat and stuff. It was a good experience.

CHRISTINE STEWART-FITZGERALD: Definitely.

NANCY MEYERS: Skin-to-skin has so many physical and physiological for both mom and baby and dad too. If dad wants to experience it as well; we know that babies stay warmer, easier and burn those calories doing skin-to-skin.

Moms’ body temperature will adjust to whatever the baby needs. It does help moms’ milk production. It does help the endorphins to help generate that let-down. A lot of times, we encourage mom to pump while she’s doing skin-to-skin. So, even though the baby is not ready to even [inaudible] feed or even Gavage feed; feeding through a tube into their tummy.

We can place the tiniest of babies even on ventilators with all those lines and cables that she talked about. We want those babies doing skin-to-skin for so many reasons. A lot of times, they will stay on mom’s chest for two, three hours and the smallest baby is tolerating. That’s absolute best place for them to be.

CHRISTINE STEWART-FITZGERALD: Parents are the main family care givers, is there anyone else allowed in the NICU. If there are older siblings, can they come in? What about grand parents?

NANCY MEYERS: It really varies from NICU to NICU what their visitation if you will policies. We don’t consider parent’s visitors. There are partners and the carer in the recovery of their baby. Typically, most NICUs are cautious of how young of a child though let it in because of the risk of the colds and flu etcetera – that kids’ going to acquire and bring with them.

We certainly encouraged any older family members, grandparents, aunts and uncles to help support the parents at the bed side. A lot of the times, that can be limited in number just because it isn’t ICU environment and again, the noise and we’ve got lots of things, small things going on.

Private occupancy can help minimize that but if it’s an open day kind of NICU like a Tri City is, you may see only two at the bedside.

CHRISTINE STEWART-FITZGERALD: So, for the parents that are visiting – what are some of the rules and sort of the guidelines, what can they expect in terms of visiting hours; the time they spent there, the type of interaction?

NANCY MEYERS: Again, kind of NICU is unique. We encourage parents to be there as much as they possibly can with mom recovering with their siblings at home 24/7. It doesn’t mean necessarily mean be there 24 hours a day. But, our doors are always open so that anytime any time of the day and night, they want to come and be with that baby; help care for that baby, we’re there. The baby’s there and we openly encouraged them to do that.

Again, it might hit the beginning very minimal what they can do just touch time. Maybe some skin-to-skin but we encourage our parents and support our parents in gradually is that baby gets better to become more actively engaged in the care of that baby from diaper changing to anything and everything that their baby’s need from them as a parent.

CHRISTINE STEWART-FITZGERALD: Well, thanks so much Nancy for joining us today. For more information about: “Inside the NICU, what to expect” or for more information about any of our experts or panellists, visit the episode page on our website. This conversation continues for members of our Twin Talks Club.

After the show, Miss Meyers will tell us about: “How parents of newly admitted new babies in the NICU can keep their sanity.” So, for more information about the Twin Talks Club, visit our website: TwinTalks.com.

SHELLY STEELY: Today on our Annoying Comments People Make to Twin Moms, we have Jamie in San Francisco. Jamie says:

“I have fraternal boy-girl twins. Yesterday, I almost smack this lady for being so ignorant. She was telling her son while pointing at my babies – Look son, that’s our future right there. Those are cute boys. Are they identical?” I said: “No, they are a boy and a girl and not two boys.”

Not to mention, my daughter was in a pink dress. After I told this woman that it’s a boy and a girl, she had the nerve to say: “Well, she would make a cute boy.” Really? I took everything I had not to call her the names that I wanted too.” -Jamie

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CHRISTINE STEWART-FITZGERALD: So, that wraps up our show for today. We appreciate you listening to Twin Talks. Join in on the discussion by posting your comments on the Twin Talks Facebook page or call in our voice mail at 619-866-4775.

Don’t forget to check our sister shows:

• Preggie Pals for expecting parents
• The Boob Group for moms who breastfeed their babies
• Parent Savers an online support group for the new parents.

Next week, we’re going to get: “Tips on creating a routine for your new born twins.” This is Twin Talks, parenting times two.

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

SUNNY GAULT: New Mommy Media is expanding our line-up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or an organization interested in our network of our shows through a cobranded podcasts, visit www.NewMommyMedia.com .

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