Leaving Hospital with a Premmie (or two).

When you are pregnant, you normally anticipate things will go a certain way; maybe the way previous pregnancies have gone, or maybe better! Some people expect particular hiccups because of their medical history and so on.

For me, I expected two things. Literally, I expected two babies, because I was pregnant with twins, and secondly, I expected to need to fight hospital policy. I think every IRONY light in heaven and earth was flashing, when at 34 weeks, I sent my husband and son to Adelaide for some follow up medical visits, and my daughter went to visit a girlfriend for the morning. Ah, peace… I remember I was going to rest that day; I was going to read, and I was going to spend some time at peace. Just as soon as my midwives visited and left. Except things didn’t quite work out that way. My midwives walked in, said “ooh, you don’t look very good” (which is what every 34-week-pregnant-with-twins woman wants to hear) and “go pee on this!” Having experience peeing on sticks, I did as I was told. It was more fun finding out I was pregnant than it was finding out I had protein out of the stratosphere. Blah. Add the revolting oedema that made my ankles practically slosh, and the blood pressure paralleled only by a job interview for a position you really want, and there I was, at home, my family elsewhere, being told to pack and bag and go to the hospital.

So, all the fight out of my sails, that’s how I was going to end this pregnancy. A premature Caesar at 34 weeks. Perhaps you’re pregnant as you read this. Listen, when you’re done, spend a few minutes looking into what you want to do if your baby is born early and needs to go to special care. I had done a little bit of reading, but there was so much I didn’t know until well after we all came home. I’ll say from the outset – we all make it home safely.

The birth story is pretty good, and the way my friends helped look after my two big kids was just fantastic, but this blog post is really about getting out of the special care nursery (hereafter, SCN). You may have read my earlier post about baby wearing in the nursery… if not, check out LINK. Being in the SCN was awful – fine for a day or so, but after that, really tedious. Every nurse had a different opinion on everything, from sibling visits to bathing to feeding to formula. If you are ever in the same situation, it would help to know what you think about all these things. For us, we just flew by the seat of our pants as we worked on getting the babies from 1700g and 2200g to the acceptable-but-arbitrary-weight-required-to-go-home.

Finally, our featherweight baby girl hit 2200g. We’d been in the nursery for a life time, but on day 20, we were finally able to fly the coop! We had the two car capsules installed, and like all parents of newborns, we did the strange journey from the maternity area to the car park.

However, we did it a little differently to most parents. I slipped my ring sling – just the one – over my shoulder, and settled their tiny 2700g and 2200g bodies on my chest. I settled them in tummy-to-tummy (theirs to mine) and side by side (one another) as I had so many times for cuddles, and we waited for an ice age for the doctors to officially say “go on, get out!” and then we stood up, and walked out the door.

We knew a bit about how we wanted to parent; we have two older children and had been working on refining our beliefs and practises for a while. While the babies really were small, they were also healthy and strong. We saw no reason not to use carriers, and saw a lot of good reasons why we should.

• Kangaroo care has been shown to benefit premature babies
• Keeping the newborns close allowed us to continue being involved with our older kids activities- and our own
• Wearing the newborns meant we could respond to their needs more quickly
• Wearing the newborns meant my precious, residual, often depleted energy was conserved by not having to get up and down to them constantly

If you have a premature – or even small-for-dates baby – unless you are given a solid medical reason not to, baby wearing is going to help you. Unless there’s a medical reason not to, baby wearing is going to be beneficial to your baby/babies. Whether your premmie (or preemie – both are used) is your first child or your tenth, you are going to want them to feel settled, calm, peaceful and secure. Keeping them close to your heart is going to do this. You might choose not to socialise – especially out of the home – for longer because of immunity concerns; you may be recovering from major surgery and not as mobile as you normally were; you may have had weeks in special care where you had every last drop of self-assurance and strength removed from your body, but there comes a point where you are free to make the parenting choices you believe to be right. Go for it!

A premature baby can be worn in a soft sling or a soft wrap. My own experience has been that a mei tai is too large and a soft structured carrier is too inflexible, but you may have a different experience. Do join the Baby Carriers Downunder forum if you haven’t already – people are always willing to share their experiences and help you find your way on this parenting path.

I don’t think these photos are particularly flattering to me - but here you go: Ruby leaving the hospital with the twins at 20 days.

Have you left hospital with a special care baby? A premmie (or two)? Another baby who had a special care start to the world? How did you find it? Did you wear your special care baby? Leave a comment and let us know!

Steph’s recent post on tummy-time mentions the increasing incidence of plagiocephaly - literally, a misshapen skull. One reason for the rise is certainly the increased numbers of babies sleeping on their back, which is recommended as being the safest way for babies to sleep, avoiding SIDS.

However, there are other causes of plagiocephaly, including craniosynostosis, which is caused by the premature fusion of sutures (joins) in the skull plates. This was our experience with our second born…

I wanted to share our experience on the off-chance it may be meaningful to another family. The incidence of craniosynostosis in Australia is about 1 in 2500 births. Our surgeon has told us that the majority of cases have no known cause (although some do have associated syndromes, our son did not), and that the fusion occurs during the second trimester of pregnancy. I should point out that I am a mum with no medical background.

We noticed the shape of our son’s head as being ‘different’ within hours of his birth. Initially, I was told it was swelling from moulding during labour; but basically, from the day he was born, he looked slightly asymmetrical. Not unattractive but just a bit skewed. Some days it was more pronounced than other days, and looking at photos, it always seemed more noticeable. He had one eye which looked more swollen/closed than the other, and as the months progressed, his face really started to contort to a C shape. I have been told that you will see it a lot more clearly in a mirror or in photos.

Over the first 6 months of his life, I asked questions of my midwife, saw a cranial osteopath, and spoke to other parents. It wasn’t until he was 6 months old and three people commented on his noggin within a week that I really pushed my GP for a paediatricians referral. I waited a couple of weeks for a paeds appointment and I went to see them when my son was 6 1/2 months old, had plain x-rays taken that day, and within two days he was diagnosed with cranio. Until then, I had only read about positional plagio, and hadn’t realised there was a difference. We went to see the Australian Cranio Facial Unit within 2 weeks, had CT scans and some other assessment, and had surgery in September. Everything moved pretty quickly after the diagnosis.

Positional plagiocephaly (caused by sleeping in one spot etc) is different to craniosynostosis, and its treatment is different. Craniosynostosis is treated surgically. My son had unilateral coronal cranio; he had cranial vault remodelling (CVR) in September 2006. As at March 2009, he is 38 months old, 28 months post surgery, healthy, strong and attractive, with a scar mostly hidden by his hair.

I’m not an expert, but if you have any concerns about the shape of your child’s head, I would recommend getting a referral to a paediatrician. My GP did not think there was a problem with my son, and no one else ever picked up on it either. My son was almost 7 months old when diagnosed, which is considered pretty late (very late?) - it is certainly better if it is picked up earlier. If you feel there’s a problem, don’t stop looking for answers until you are satisfied.

I would be happy for you to contact me - leave a message below! - if you’re facing a cranio diagnosis.

Of course, a post about baby wearing while in the hospital is sure to follow. As are posts about baby wearing in a new city; while travelling to and from interstate medical appointments; while doing laundry in short-term accommodation… you name it, a medical condition can make a difference to where you’re carrying your baby geographically, but you always wear your baby in exactly the same place: close to someone who loves him.

Resources:

Further information on craniosyntosis.

Have you faced a diagnosis of either plagiocephaly or craniosynostosis? Were you aware of the difference? Do you need to connect with someone who’s faced this diagnosis? Do you know someone else who does? Leave a comment. You’re not alone!

One of the common misconceptions circulating in babywearing circles is that time upright in a carrier can be equated with “tummy time”, or time an infant spends playing on its tummy. These two activities should not be equated, there are important differences for the child’s development in each position. However, there are also many similarities and time in a carrier is a good alternative to tummy time when the latter is not practical.

Tummy Time

“Tummy time” is commonly defined as time an infant spends playing on its stomach while awake. It is commonly recommended by many medical professionals to start at birth as a way of reducing or avoiding the mishaping of an infant’s head (plagiocephaly) caused by too much time in one position.

Tummy time also has the benefit of strengthening an infant’s abdominal and chest muscles while offering a different view of the world and an opportunity to engage with it directly as a tactile experience, rather than observing it while lying on the back.

However, some babies, especially those with reflux, protest and detest tummy time.  Many parents are left wondering whether an activity so distressing to their child could be beneficial developmentally while worrying that failing to engage in regular tummy time may result in an avoidable disfigurement for their child in the form of plagiocephaly.

The good news is that babywearing is an alternative to tummy time. The common misconception, however, is that the two are equal.

Sling Time

Like tummy time, sling time has many benefits for an infant’s development. Upright time in a carrier removes pressure from the back of the head (present when the baby is lying on its back), reducing the chance of plagiocephaly quite effectively.

Time spent upright in a sling also exercises many of the same core stability muscles that are used during tummy time, however these muscles are not being used to the same level of exertion over the same time period as tummy time. Consider doing a pushup on the floor (or not). Now, think about pushing up while leaning against a wall. The latter is much easier, thanks to gravity. This is a similar comparison to tummy time and sling time. Another difference is that upper abdominal muscles may be used to a greater extent than lower abdominal muscles during sling time. The reason for this is the way the child is secured to the caregiver in the sling.

Since a baby is less likely to be frustrated in a sling and spend much longer in a sling more regularly throughout the day, the overall cumulative effect of sling time will be very beneficial to the development of these core stability muscles. The stimulation of the world around the very young infant will provide a very good incentive for the baby to develop its neck muscles from a very early age. In addition, since the babywearer is generally moving about while carrying the infant, the baby’s sense of balance and movement will also be developed.

There are several benefits of tummy time that sling time does not replicate, however. When a child is playing on its stomach, it can reach for (and usually mouth) toys. Gradually this will develop into a desire to move towards a desired object. Although a child can be given a toy to manipulate while it is in a carrier, this latter encouragement to take the first steps towards autonomous movement is missing in the carrier. Not all the same muscles are used to the same degree when in a carrier compared to when a baby is on its stomach. With this in mind, however, there are many benefits of closeness to a loving caregiver while in a sling that tummy time cannot replicate. Time babywearing can be used as a good way to develop those gross motor skills an infant needs to find tummy time less frustrating.

Conclusion

Although tummy time and sling time are not entirely interchangeable, they are two similar forms of exercise for an infant, each with benefits. Sling time, while not replacing tummy time, can help reduce the probability of placiocephaly while also developing core stability muscles in the worn infant. It is a good alternative to consider when a baby is frustrated by tummy time and an easy way to develop a child’s muscles in preparation for tummy time. However, time spent on the stomach should be introduced at some point for optimal development of gross motor skills.