IUGR, bub will likely arrive before 34 weeks........what to expect?

[Janie]

We found out yesterday that our baby is IUGR. For now they are keeping an eye on things, and I am having monitoring every second day, and another scan in just over a week. Our Ob doesn't expect bub to be able to stay inutero after 34 weeks, but of course just when s/he is born depends on how things progress over the next few weeks. He is trying to prepare us for it even being in the next week.

Obviously there are a lot of different scenarios here.........a baby born at 30 weeks has very different needs to one born at 34 weeks. It seems that they would really like to keep baby in until 32 weeks at least, but not to the detriment of the baby of course. So it's a juggling act. I have been having mild contractions, so have been on meds to stop them. After this diagnosis, I am to stop the meds. Ob doesn't want to artificially stop labour if there is a reason baby is being evicted.

Our first DS was a 35 weeker, similar scenario, but less extreme and later in the third trimester. I went into labour after PROM, and he was born very healthy, albeit sleepy! Only 24 hours in SCN, and then in with us, and home with us. We had ALOT of feeding issues (one thing I was hoping NOT to repeat this time ). He was FTT for a few months, but then picked up. We have since found out that he has multiple intolerances (dairy etc).

I have alot going through my head, and so many questions I don't know where to start. I would appreciate any info that can be given as to what to expect, from now until 34 weeks. Feeding stuff (although I'm pretty well up to date with this stuff, I'm not so sure about SCN practices), breathing stuff, birth stuff, emotional, practical, whatever you think might help. We're obviously quite concerned for our 2 year old as well, it's going to be a tough time for him too .

TIA from a mummy who is trying not to stress out too much

[Inanna]

Cuddles again my friend.

Yes, if the baby is born now it will have quite different needs to a 34 weeker. Most markedly breathing issues. Most babies born this early will require CPAP (Continuous Postive Airway Pressure) or ventilation. It can be confronting to see this. with CPAP the baby has tape on it's face and a "snorkel" with tubing attatched to the machine. I will find some information and post it. This machine basically takes the pressure off the baby's lungs that are not meant to be functioning yet. So the baby will still breath but it gets that positive pressure to make the job a bit easier.

The baby will be in a incubator or some people once called it a humidi crib. The environ is warm and constant - trying to be womb like. Initially minimal handling is done - as each movement uses the baby's much needed energy. Parents and siblings can visit the cot side of course and parents are encouraged to lay their hands on their baby. I made a very conscious effort of sending energy to my baby when I did this. Directing love and positivity to the baby. I also asked for photos of my kids to be brought to the hospital and they were taped to her cot. I also put positive affirmations on her cot. Any toys etc will be encased in a plastic bag and kept outside the cot. You will be encouraged to help with yoir baby's cares - changing nappy, wiping with cotton wool etc... It is scary at first as they are so tiny - but in time it becomes more doable.

The alarms are difficult to get used to. Of course there are oximeters, ECG's etc and when the baby's heart rate falls below a specific level the baby will alarm. These are called bradycardias... Or colloquially brady's. Most preterm bubs have some of these. (Imogen had them constantly and it was so damn tough...). Also this can happen if one of the probes comes off your baby's chest.
So along with your baby there is likely to be another 8-10 baby's in the same bay. Each high risk baby has it's own nurse. Your baby if it is born in the next week will have it's own nurse until he/she is stable. Then one day you will notice your baby is being nursed with another baby (cared for by the same nurse)... You know things are improving when this happens!

Handwashing is a religion in NICU. You will gown up and remove all jeewellery and scrub up. You don't touch your face or hair or anyone's whilst you are gowned and scrubbed. Just your baby. Prems like a firm touch - no stroking. I read to Imogen every day. I also played music to her with a cD player and cd's that I asked to be brought up. I would recommend this. It concerned me when some parents played JJJ to their bubbies...

If anyone has a cold sore or any sign of an illness they need to stay away. If these babies catch an infection it can be fatal. A common cold can kill in NICU.

You will be encouraged to express regularly. I expressed 2-3 hourly every 24 hours for 15 weeks. It is very bery important for prems. Prems that have formula don't have as good outcomes as those that have breast milk. Largely gut problems.

I was very very militant and told them she was under no circumstances to have formula. I had some donated EBM but my body decided to co-operate and she was fed my milk through a naso gastric tube at 4 days post birth I think it was...

Your baby will have an umbilical line which is where they will put iv fluids and any meds he/seh may need.

If he/seh is born at 34 weeks the treatment is quite different. It is possible that he/she will just need the sCN - though possibly after spending a little time in NICU. He/she may not need ventilation but again probably a little cpap initially. But of course not always.

I recommend talking to your baby a LOT. I read stories, I cried, I laughed and I cried some more. It for me was a desperately lonely and difficult time. I lived a distance from family and friends... Abnd I had a very unsupportive partner. Your situation is going to be different. Also your baby is bigger and you are well.

I would choose some books and have them ready. Get some music and a cd player. Start playing the music now...

I will BBL

[Rivlas]

HI Janie, sending you hugs.

Remember I am just around the corner, well a few, but call me if you need any help.

[Early Kids]

You've done so well to get to 30 weeks. A friend of mine had twins at 32 weeks, both IUGR (1080 grams and 1200 grams) she started having troubles early on, but they picked up the IUGR at about 24 weeks. When they were born they went onto CPAP for a few days. They did as well as anyone would expect for a 32 weeker, despite their size. I have a lot more stories with similar outcomes. Size does not always affect how well a baby will do once born. It can go either way really.

I can tell you that the difference between a 30 weeker and a 34 weeker is HUGE. Brendan 6 weeks in hospital, nearly died a few times, quite a lot of issues. Tristan had some breathing trouble, some feeding trouble and jaundice. BUT it really is an individual child thing. Tristan did exceptionally well for a 34 weeker, and Brendan did poorly in his first few weeks, but then excelled.

I wish you all the very best, there are plenty of people here for support

Inanna has pretty much covered it.

[*Beema*]

Aww hun, just starting with a big and you have done an amazing job to bring your little one this far, and I feel tht you have a few more weeks of baking to go.

I am sorry to hear that your pregnancy isn't going how you had wished, and hoped for. There is quite a marked difference between a 30 weeker and a 34 weeker. DD was born at 33 weeks and had a reasonably smooth rider the SCBU, she was a good size and didn't have any breathing issues. A close friend had her little girl on the same day, and she was a 34 weeker and ended up requiring the vent and CPAP dues to respiratory distress syndrome, both bubs were delivered via VB and were average size.

Have they given you steroids to help develop your precious one's lungs, is it something that your OB has mentioned?

The monitoring is a good thing a friend was monitored every 2 days from 30 weeks then they went to daily at 35 weeks as her DD was SGA, they ended up delivering her at 36 weeks @ 2kg. The extra time in Utero made a huge difference. I really hope you can gat a few more weeks.

Innana has covered most of the NICU terms, I dearly hope that you don't need to go down that path and the few extra weeks will make the difference.

One thing I would really like to recommend is writing in a journal, a blog, or where ever you need to, I found that it was a really good way to record what happened each day, I started my during my pregnancy, and have continued it through, what it gave me was an outlet, somewhere I could write all of my fears, concerns, stressful moments, but most importantly every moment to celebrate and be proud of. I know so many people who wish they had recorded there little one's journey, especially those who have been through the prem experience. At the time things can be a bit of a blur, the wizzing on information in fromt Dr's and Nurses can be quite overwhealming.

Have you had the opportunity to do a tour of a NICU and SCBU (SCN)? Where they would be able to show you bubs that are of a similar size to your little one, it will help in gaining perspective, and and idea on what to expect. I just recently went through our NICU and was honoured to have the opportunity to meet a wee little bubba at 380grams, and a few at 700grams, a friend has just recently has a 25 weeker and at the time of my visit he was the same size as the bubba's I met and it really helped me gain perspective on how bit that actually is.

When I'd had DD I didn't get that opportunity so it was quite confronting, and it was all a bit of a blur and I didn't know "where I stood" as such. Where as now I have a much greater understanding and actually going these makes it a lot easier to understand and comprehend what it will be like rather than just looking at pictures and talking to people.

I hope that your little one keeps on baking and growing to stay inside that bit longer.

Take care and I am more than happy to chat more
*Can you empty out some PM's too your inbox is full!
xxoo

[HotI]

Janie,

Hoping bub can stay in a bit longer, and grow a bit stronger.

take care,

Kate

[squidipa]

i have massive hugs for you we have the same issue and i am on 2 day monitoring too happy to share info with you. sorry having a bad day but did want to give you a big we made it to 34 weeks and its likley they are gonna keep pushing us longer. would love to compare weights with you

[Inanna]

Just remembering that weigth comparison is not really helpful... Of course the bigger the better - but gestational age is important. Simply a baby at 34 weeks has developed more surfactant an other areas of development. So the gestational age is quite important.

Imogen was 815 grams (though the hospital records say 805 grams so maybe I was in error there!) at 27 weeks 5 days. Other babies of the same gestation were 1200grams.... Babies at 25 weeks were 800 grams...

Just try to let go of figures & know that if the baby is born now it will likely be fine after a stay in NICU/SCN...

Your baby Squidipa is very likely to need a stay in SCN as it will be more developed but hopefully will bypass any assisted breathing - especially if he stays in there for another week or so.

[mrsmac]

Just wanted to send you a big hug Janie, I am thinking of you. Wish you weren't so far away or i'd babysit or cook for you.

[*Beema*]

Just remembering that weigth comparison is not really helpful... Of course the bigger the better - but gestational age is important. Simply a baby at 34 weeks has developed more surfactant an other areas of development. So the gestational age is quite important.

I agree, but I think the total of the Gestational Age and the Weight also go hand in hand, it really depends on what is causing the IUGR, as some reasons can actually delay the development of the organs, so even though bub may be a 32 weeker, there size and development can be set back a few weeks. Especially as a friend had a 32 weeker who was only just over 950grams, he had a very long NICU journey.....

Just remember that every prems journey will be different, some issues will affect some and not others, I dearly hopw that your little bubba will have plenty of baking time left and lots of growing, and hopefully will result in a smooth fattening up farm.

This is by no means to scare you Janie

[Inanna]

Very true Beema Just keep that in mind Janie - each baby has it's very own journey... Immy was so tiny & she took a long tine to come good... But she also had much less time inside.

There were other babies born at the same time who were gone in 6 weeks!

I have a very good feeling about your precious baby... Because he/she has a very very special Mama... If any baby has the right NICU mama it's you darling woman! You're going to get through this & so will your sweet one.

[Rosebud]

Big Janie. The ladies have fairly much covered everything.

If your baby will be fed EBM, you may want to check with the NICU what they offer in the way of breast pump hire. An hour before I was discharged from hospital, I was told that I had to arrange my own hire - hospital didn't have hire facility and you could only loan one from the NICU if you were not a local. Yes I did have access to the pumps in the expressing room but as I had other children at home to also take care of it was impossible for me to do all my expressing in the unit.

A diary will also become your best friend. It will help you to evaluate the events of each day. It is amazing how much you can forget as each day blends into another.

One thing that I would like to share is some advice that I received from a mother with twins in the NICU. She told me "you are your baby's advocate and nothing is stronger than a mother intuition". If you feel that something is not right don't be afraid to voice your opinion not once or twice but as many times as you feel necessary. To this day, I strongly believe that this little piece of advice saved my child's life.

Sending healthy and strong lung developing vibes your precious bubs way.

Take care!

[Early Kids]

Definitely agree on the each baby has it's own journey. Tristan was 3kg at 34 weeks and still required ventilation and then CPAP. The first day or two is mostly the scariest, the journey is very much a roller coaster ride... bub doesn't do so well, then they excel, then they drop back again. The few days before home are the most frustrating, you are so close you can feel it and then there's a set-back.
In my experience it also highly depends on the hospital and the Dr bub is being looked after by. Some hospitals require 2kg weight before home others 2.5kg, which could mean another week or two in hospital.

Do you live close by the hospital?

[Amity]

I have a double Medela breast pump you can borrow for as long as you need. PM me and let me know where I need to drop it off.

DS1 was 34w... but I was in hospital from 28w as he was IUGR and I had bad P/E. He was born at 1950gms... still tiny. But he was very "well developed" for his gestational age and I took him home at 10 days old and 2020gms... and am still amazed at his growth and development. No NICU, just special care at Monash - they're blooming marvellous.

Thinking of you - Please PM me...

[Ginger]

Janie- i'm not sure if this is appropriate for this situation, or if this is something that would be required, but if you need some EBM i would be more than happy to help you out with some. please let me know xoxo

[didispunk]

Jorda was born around that time as well.. she was 6.9 and not in NICU and was a poor breastfeeder, but healthy otherwise.

[Sally2]

Oh, well done on keeping that little one baking away!
Every journey is different, you just have to walk it and take one step at a time. At 34 weeks, baby should be breathing well etc just need to learn how to feed so NG tube until the suck reflex comes in..... but all kids do things at their own pace......
Just take pleasure in the small things, kangaroo care when you can and remember, there will come a day when baby is sleeping in their own bed at home......

[Loula]

Hun you know i have no experience with this but want to tell you im here. i havent been over yet (and i need to give you back your bowl) but let me know what i can do, do you wnat me to bring you and DH dinner one night? i make a great spag bol and you just missed out on shephards pie lol but im sure i can create something if your willing to try lol