Thursday, March 27, 2014

Questions to Ask about Preemie Delivery & the NICU

If your doctor has suggested that you may have a premature baby that will require a Neonatal Intensive Care Unit (NICU) stay, it is important to ask many questions to be prepared.

I knew that my baby would come early, but didn't think she would enter the world at 28 weeks gestation. Unfortunately, I did not have time to tour the NICU or visit with neonatology staff until I was hospitalized at 25 weeks gestation.

Below are some of the questions my husband and I asked the neonatology nurse practitioner prior to my c-section. I hope this list is helpful to other families who may encounter a similar experience and don't know what questions to raise.


DELIVERY QUESTIONS

The delivery of a premature baby could be very different from the delivery of a full-term baby.  Depending on the situation, you may not have time to ask many questions, as delivery may be imminent.

In my case, the doctors and nurses took a "wait and see approach" when it came to delivery. They were ready to perform a C-section on the night I was admitted, if necessary, but were also hoping to delay such surgery.
 
Fortunately, hospitalization allowed me to keep my baby baking for three more weeks.  This gave me time to develop thoughtful questions, including:
  • How will you determine when delivery is necessary?
  • Do you anticipate the need for a c-section?
  • Will I need steroid shots?
  • Will I need magnesium sulfate?
  • Who will determine when delivery is necessary (i.e., the obgyn on call, the perinatologist, or both?)
  • Will NICU staff be at the delivery?
  • What will my baby look like when born?
  • Do you think my baby will cry when delivered?
  • Will I be able to see or hold my baby immediately following birth?
  • Can the baby's father be in the delivery room?
  • How long will I have to wait in order to visit my baby in the NICU?
  • Where will Mommy stay while recovering in the hospital?  And, how far is that from the NICU?

NICU QUESTIONS

Depending on your situation, you may or may not have time to tour the NICU and visit with a neonatologist prior to delivery.  Below are some of the NICU-specific questions that we raised:
  • How quickly will my baby be taken to the NICU?
  • What kind of special needs do you anticipate for my baby?
  • How long of a NICU stay do you anticipate?
  • When and how often will I be able to participate in kangaroo care with my baby?
  • Will I be able to help provide my baby with basic needs (i.e., changing its diaper, taking its temperature, etc.)
  • How often will I obtain updates from the neonatologists?
  • Will my baby have a primary neonatologist and primary care nurses?
  • What safety mechanisms are in place in the NICU to avoid the transmission of infections and illness?
  • Are there any special shots or vaccines that I or visitors should get to protect my baby while he or she is in the NICU?
  • What items am I allowed to bring into the NICU (i.e., a Boppy, baby clothing, baby blankets, books, cell phones, smartpads, laptops, etc.)
  • What is the NICU visitor policy? 
  • Are siblings and grandparents allowed in the NICU?
  • How many visitors are allowed in the NICU at a time?
  • Do parents and visitors need to wear masks, gowns, and gloves in the NICU?
  • Will I be able to dress my baby in clothes?
  • Will I be able to get updates concerning my baby from home?

PARENTAL SUPPORT QUESTIONS

A NICU stay is a roller coaster ride for a baby and his or her parents. It is very difficult to go home without your baby, when all you want to do is be with him or her. We asked the following questions about parental support, resources, and hospital discounts:
  • Are parents able to spend the night at the NICU?
  • Is there a NICU lounge for parents?
  • Is there a NICU support group for parents?
  • Does the NICU have hospital grade breast pumps that moms can use while visiting?
  • Does the hospital have a program that allows you to rent hospital grade breast pumps for home usage?
  • Are there any shower facilities for NICU parents?
  • Are there any books or other resources you recommend to become more familiar with the NICU and the medical procedures my baby may need?
  • Which parking lot is best to use when visiting the NICU?
  • Does the hospital offer NICU parents discounted rates for parking?
  • Does the hospital offer NICU parents discounted rates for cafeteria meals?

HOSPITAL TRANSFER QUESTIONS

Just like snowflakes, not all NICUs are the same. In fact, there appears to be no uniform national definition for the various levels of NICU care across the nation.  NICU levels vary by state.  Some states have defined three levels of NICU care; other states have defined higher levels of care.

Some NICUs are able to take care of extremely small and sick premature babies.  Many of these NICUs are able to conduct surgeries on preemies.  Other hospitals are not equipped to handle these types of premature babies and must transfer them to other facilities, when appropriate. 

My daughter was born at a level III B NICU in Virginia. We were told that she would need to be transferred to the nearest children's hospital, which offers a level IV NICU, if she required complex surgery. Although this was unnecessary, we asked the following questions about hospital transfers in order to be prepared:
  • What level NICU is offered at this hospital?
  • What circumstances would require the transfer of my baby to another hospital?
  • In the event that my baby is transferred to another hospital, how quickly would the transfer occur?
  • What safety protocols are in place for the transfer of babies?
  • Will a family member travel with my baby during the transfer?
  • How will I be able to stay up-to-date on my baby's condition if we are in separate hospitals for a day or more?
  • If my baby is transferred will he/she stay at the other hospital for the duration of his/her NICU stay or eventually be transferred back to this hospital?
I hope you find these questions and my personal story to be helpful.  Preemie Blessings wishes you a smooth delivery and NICU stay!

5 comments:

  1. This is great info for parents.Great to have in your bag for the hospital as once the baby is delivered your will have a hard time remembering these things

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  2. Tara, Thank you for your thoughtful comment. You made a really great point! This might be a helpful list for mom's to put in hospital "to-go" bags, just in case.

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  3. Good idea to pack in the go bag!! In the moment, everything can flush out of your brain. Thanks for sharing this, Michelle.

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  4. These are very thoughtful and insightful questions. Some NICU's may have handouts to read that may answer some of these questions. You could send these questions into the nurse manager in the NICU that you graduated from and maybe she/he could make these questions into a handout. Just a thought... :) Great post!

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  5. This is all GREAT info. My son was premature and born with a life threatening birth defect so we spent almost two months in the NICU. I wasn't aware of any health problems during my pregnancy or that we would go early so I was in total shock and had a million questions. I remember upon arriving I didn't know that we could stay at the Ronald McDonald House that was connected to the hospital. But I know once my son was life flighted and I was at the hospital the first night by myself because I couldn't be released until that morning I googled everything about the NICU because I was totally clueless and had a million questions. Thank you so much for this post and I know that two years ago I would have appreciated reading something like this!!

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