Canadian NICU Support Foundation: World Prematurity Day at Foothills Medical Centre

Canadian NICU Support Foundation: World Prematurity Day at Foothills Medical Centre: Hi Moms and Dads: If any of you are in Calgary, Alberta, we would love to have you join the Foothills Hospital in recognizing World Prem...

SMILE Cookies in support of NICU

http://www.timhortons.com/ca/en/difference/smile-cookies.html

Alberta babies more likely to be born earlier, smaller

Alberta babies more likely to be born earlier, smaller

Mother's Day Run

Injured boy, 8, dedicates Mother’s Day Run to mom killed in accident (with video)

MOTHER'S DAY RUN

TEAM ELIE WAS AWESOME TODAY, THANK YOU TO ALL OUR FRIENDS AND FAMILY FOR COMING OUT AND RUNNING/WALKING IN SUPPORT.  OVER 14,000 PEOPLE CAME OUT THIS MORNING TO HELP RAISE MONEY FOR THE CALGARY NEONATAL INTENSIVE CARE UNITS.

WE ARE FOREVER GRATEFUL TO THE DOCTORS, NURSES AND ALL THE STAFF WHO HELPED IN THOSE EARLY DAYS.  WE ARE IN AWE OF EVERYTHING YOU GAVE AND THE INCREDIBLE DIFFERENCE YOU HAVE MADE TO OUR LIVES.

THIS WILL NOW BE OUR MOTHER'S DAY TRADITION - A GOOD REMINDER OF LIFE'S BLESSINGS.

Benefits denied! UPDATED

I just found out today Manulife will not cover rental or purchase of breastpump under my benefits plan, notwithstanding that it is considered medically necessary.  Given the length of stay in the hospital, his inability to breastfeed afterwards and his allergy to milk protein, I am appalled that a carrier would deny such expenses.

Stay tuned, lets hope that with a little more investigation the appropriate person intervenes.

UPDATE:

I raised the issue with my Benefits Manager and she agreed to follow up.  She advised me yesterday that my employer has expanded coverage to include pumps under their contract with Manulife.  Not only have they taken steps to ensure my expenses be covered, but any colleague will be able to claim for the cost of a breast pump.  This is such a relief and I am so impressed with how they handled this matter.  THANK YOU MR!

Sportchek Mother's Day Run & Walk 2012

Premature Baby Deaths Preventable

http://www.guardian.co.uk/society/2012/may/02/premature-baby-deaths-preventable-report

15 Million Premature Babies Born Each Year

http://www.cbc.ca/news/health/story/2012/05/02/premature-births.html

Hostage to the Pump - PROS & CONS

For the first 6 weeks of his life, my son received all feeds by nasal tube.  The nurses explained that usually they see babies discharged (provided they meet the other discharge requirements) approximately 5-7 days from the time they are receiving 50% of their feeds by bottle or breast.  It wasn't until he was 35 weeks that we even started to introduce the bottle.  We had focused on feeding him with the bottle because it was easier to measure his intake and he was a very slow gainer.  The biggest issue we had in the last 3 weeks of hospitalization was his slow weight gain.  We tried to get him breastfeeding but we were nervous about how much he was actually removing from the breast and so we stuck mainly to bottle.  After much discussion with the doctors, we agreed to maintain the bottle feeding and only increase breastfeeding one additional daily feed per week.  My father was gravely ill and so I liked the flexibility to travel without my son that pumping gave me.

I struggled with whether there was any downside to continuing exclusive pumping and asked nurses and doctors their opinions. They all told me it did not matter, other than breastfeeding removes milk more efficiently so I may spend more time pumping.  In my case, they were wrong and it did matter.  If I had the choice again, I would have tried harder to breastfeed rather than express my milk.  Here's a point form list of the pros and cons associated with exclusively pumping:

CONS

1. Time: it takes twice as much time to feed my son than if I were breastfeeding. 
2. Difficulty timing pumping and feeding: invariably my son was hungry whenever it came time for me to pump.  Over the last 7 months I have often found myself in the awkward situation of not knowing whether to feed him or pump.  This results in either an unhappy baby or uncomfortable breasts.
3. Drop in Milk Supply: within 6 weeks of my son returning home, I noticed a significant drop in my milk supply.  I believe the inefficiency in pumping and less skin to skin contact are factors that contributed to that drop. Because my supply dropped, I also began to ovulate which resulted in a further drop in supply.  The drop in milk supply has caused so much anxiety it is difficult to put into words.
4. Travel is difficult: I mistakingly thought pumping would give me freedom but it hasn't turned out that way.  The last thing I want to do when I'm on the plane is pump in the bathroom.  It is much easier to breastfeed in your seat - there is no way I am ever pumping at my seat, even under a cover.  The pump is so much more conspicuous than a suckling baby!

PROS

1. Help from others: Other people are able to feed the baby because he/she is bottle fed.  Not only does that lift some of the burden from your shoulders, but it permits other people (fathers, grandparents) to more fully participate in caring for the baby.  It allows others to bond with the child and learn to comfort the baby in a way that is often reserved for the primary caregiver.  
2. Time away: Allows me to be away longer than I would be able to be if I were breastfeeding.  I've made several trips out of province for family matters and my son is able to rely on my frozen reserves during that time.
3. Reserves: I was able to build up a large supply of frozen milk that I rely upon when I'm away or when I want to partake in a few too many glasses of red wine.  
4. Better monitor intake: We are able to monitor precisely what my son's intake is because he takes a bottle and therefore better able to know if he is getting enough milk or going through a growth spurt.     

Ultimately, the decision to exclusively pump or not may not be your decision.  We were warned that it can be difficult to get your baby to breastfeed after being fed via bottle.  There is no question that babies are 'lazier' after receiving milk by tube or bottle and it can take weeks even months to get them breastfeeding.  Whatever you decide to do, recognize that it is not easy and you should be proud of the effort you are making.  Good luck!

Breast milk bank, second in Canada, seeks Calgary donors

Breast milk bank, second in Canada, seeks Calgary donors

Preemie Clothing

It is difficult to find clothing that fits preemies.  The following is a list of the best places to shop in town for small baby clothing:

Edamame Baby on 32 ave SW in Marda Loop
Sears Chinook

There is also an online store that is a good place to check out if you're pumping at home with nothing to do one night while your little one is still in the hospital.  Check out http://www.preemiestore.com/

Australian couple faces $1-million hospital bill after baby born in B.C.

This article helped me do the math on how much was spent on Elie's hospital stay.  We are so grateful!

http://www.theglobeandmail.com/news/national/british-columbia/australian-couple-faces-1-million-hospital-bill-after-baby-born-in-bc/article2383743/

News on Common Antibiotic for Prems

http://www.cbc.ca/news/health/story/2012/03/16/asthma-antibiotics-gut-study.html

BRILLIANT BEGINNINGS

Brilliant Beginnings is a one-stop resource centre for parents, infants, and toddlers (newborn-4 years) in the Calgary area. Their goal is to equip parents with the tools to understand early development and how to optimize this crucial time of learning. 
Brilliant Beginnings' curriculum utilizes a multi-sensory, active-learning approach that is shown to enhance learning in young children. Classes focus on contextual learning (themes), language & literacy, motor, and problem-solving skills all while having tons of fun! 

Brilliant Beginnings also provides a variety of services to support your child's social, emotional, and cognitive development. These include parenting support (in your home), parenting workshops, and public education.


The founder, Melanie Gushnowski, M.Sc has a Masters in Applied Psychology with a major in Human Development and Learning.  I understand Melanie  formerly worked at the early intervention clinic located at Alberta Children's Hospital and has lots of experience with prems.  This is a great resource for those of us who do not qualify for the perinatal early intervention clinic. 






http://brilliantbeginnings.ca/

Interesting...HMF by donated milk

Not available in Canada but maybe one of the best ways to help little ones...

http://thechart.blogs.cnn.com/2011/08/15/fortified-breast-milk-helps-preemies-grow/

TOP 5 RULES TO FOLLOW IN NICU

1. DO NOT COMPARE YOUR BABY TO ANY OF THE OTHER BABIES IN THE NICU
All babies are born under different circumstances and there are so many factors that influence how your baby is progressing.  You do not have all that information and the exercise of comparing your infant to the infant in the next bed who may be gaining weight faster or seeming to be getting better sooner will not be helpful.

In the event that it is your infant who is gaining well or seems so much bigger than the next infant, it is even more important to keep those comments to yourself.  A parent who is watching their infant struggle does not need to hear you confirm their worries.

This happened to us a few times, and it was hurtful to hear someone comment on how small or sick my son looked. These parents most certainly must have assumed I couldn't hear them discussing us with the nurses but I could and it was the last thing we needed in an already stressful situation.

2. DO NOT BRING MORE THAN 2 PEOPLE BEDSIDE
This is tricky.  Of course you want to show your family your baby and it is so tempting to to have your parents of other children in to see your preemie.  This is understandable.  But the NICU has rules, and they ask that you have no more than 2 people bedside during any visit.  You are not the only person who wants to have family visit the baby, every parent in the NICU feels the same. But if everyone disregarded the rules it would be absolute mayhem.  On low flow hours (early in morning or late evening), the units are often quieter and bringing an additional visitor (ie two grandparents + yourself) may be permissible but ask first.  Babies are very sensitive to noise, and 2 or 3 people per bed can amount to a lot of extra talking/noise in the NICU at any given time.  Please be sensitive to the other babies, and families and do not take advantage of these guidelines.

3. PUT ALL BAGS, PURSES, COATS AND FOOD IN A LOCKER
We witnessed a number of women bringing their purses bedside.  I have no doubt that the nurses told them that was unacceptable but since it occurred fairly regularly I will highlight the rule again.  Purses are often put on the floor, then the counter where items that come into contact with your infant are placed. So many germs and bacteria can be transferred this way.  LEAVE YOUR PURSES IN A LOCKER.

4. DO NOT HOG THE BREASTPUMPS
At Rockyview, mothers do not have a separate pumping room and pump milk bedside.  There are a limited amount of pumps and they have to be shared. Once you are done with a pump, clean it and return it to the hallway where you found it.  If the NICU is quiet and you intend on using it again shortly, at the very least clean it and place it in the pod hall so that others can spot it if they need to borrow it quickly in between your pumping sessions.  I heard stories of mothers hiding the pumps in their pods (crazy) and refusing to share, but never experienced it first hand.

5. CLEAN EVERYTHING YOU TOUCH
Once you are done with a chair, breastpump, pillow, scale, wipe it down with cavi wipes.  CONS and other infections may be able to be prevented if people diligently wash their hands and sanitize the items/objects that come into contact with the infants.  Also return all used gowns, clothing and pillow cases to the proper laundry hampers when you are done with them.

Food for Thought: To HMF or not to HMF

After battling CONS in the first few weeks of his hospital stay, my son dropped quite a bit of weight and the doctors were anxious to see his weight trending in the other direction.  Without much discussion, the put him on Human Milk Fortifier (HMF); one pack at first, increasing to two packs within 48 hours.  I attended rounds the day they decided to put him on HMF and no risks or potential side effects of the move were ever discussed.  


Within two days my son had blood in his stool and an xray revealed a lot of air in his intestines.  The doctor sat me down and explained that they were not certain, but had concerns that he was suffering from a very serious disorder called NEC.  One in three babies who are diagnosed with NEC die, so this potential diagnosis was very serious.  They immediately discontinued oral feeds and placed him on fluids to give his gut a rest.  My son did not eat for two days before the next xray revealed that it was not NEC.  They put him on an elemental formula Neocate which he tolerated.  Since it wasn't NEC, they believed that my son had developed a cow's milk protein allergy, possibly because of the early introduction by HMF.  I ended up on a dairy-free diet (which is harder than it sounds) because the protein transfers through breastmilk.  He remained on Neocate for almost 10 days at which time they slowly re-introduced breast milk.  As you can imagine, two weeks of little/reduced feeding really impacted his growth rate and his weight dropped from the 50th percentile to below the 3rd percentile (even on an adjusted chart).  


We were unable to find studies that clearly link HMF to NEC or NEC scares but heard countless stories from other doctors, nurses and moms where there seemed to be an undeniable correlation.  Doctors and parents are in such a hurry to fatten up the baby and supplementing breastmilk seems like the easiest step to accomplish that goal.  And while this goal is understandable, parents need to ensure they understand and consider whether HMF is right for their little ones.  The problem is the young gut often cannot handle cow's milk and even if NEC does not develop, the possible setbacks from a NEC scare should be considered before such steps are taken. 


I wish I had realized at the time the risk associated with introducing cow's milk at such a young age; had I known I would have insisted they push up feeds rather than use HMF.  I would never have let them use HMF on Elie.  If you find yourself in the same boat, speak to the neonatologist and see what other options you have or if you can you try to merely increase volume rather than supplement with HMF.  Breastmilk is easiest to digest and safer for your baby.


The links below provide some additional information for your consideration.  If you find yourself in the same situation, please leave a comment so that others can hear your story. 


http://www.ncbi.nlm.nih.gov/pubmed/17100376
http://pediatrics.aappublications.org/content/114/6/e699



Thanks

Hospital Grade Breast Pump

If you were like me, and had no warning of an early delivery, the last thing you had probably had a chance to get was a breast pump.  I hadn't even really given the whole feeding exercise much thought, and assumed things would just come easy.  Good quality breast pumps are crucial for moms of preemies so that we can build up our milk supply while the baby is maybe too young to breastfeed or still in the NICU.  Nurses warned us that even the most eager breastfeeders went home being bottled at least half time so we realized right away the importance of getting a good quality breast pump.  

The hospitals provide a print out of all the pharmacies in town that rent breast pumps.  We went through a dozen before renting the Medela Symphony (same as the hospital) from the Shoppers off of Macleod Trail.  They only have a few pumps so call ahead.  When my pump's motor gave out and they had no other pumps to rent, we found One Tiny Suitcase.  They rent Medela hospital grade breast pumps with free delivery. The cost was the same as with Shoppers and they had all the accessories (bottles, shields, etc).  Definitely worth the cost of a good quality pump.

http://www.onetinysuitcase.ca/

Too Early, Too Small

Too Early, Too Small: H118-56/2009E-PDF

A Profile of Small Babies Across Canada

Babies who are born preterm (before 37 weeks of gestation) or small for their gestational age (SGA) are at increased risk of mortality and morbidity. This report examines the relationship between selected factors and preterm and SGA births for all provinces and territories (excluding Quebec) using 2006-2007 data from CIHI's Discharge Abstract Database. Information on the hospital costs of preterm, SGA and low birth weight newborns is also included.

http://secure.cihi.ca/cihiweb/products/too_early_too_small_en.pdf

75% off Train Travel

Via just posted a sale of up to 75% off travel on the Canadian (Vancouver-Toronto).  RSV season is on until April so consider making the trip by train.

http://www.viarail.ca/en

Helpful Books

I stumbled across an older edition of Preemies in the waiting lounge at FMC and immediately went home and sourced it out, along with as many other books on preemies as I could find.  Here's a list of the books I found most helpful:

1. Preemies, Second Edition by Linden, Paroli and Doron (2010)
2. The Premature Baby Book by Sears (2004) 
3. The Preemie Primer by Gunter (2010) 
4. Your Premature Baby, the first five years by Bradford (2003)

Baby fat? Doctors urged to weigh newborns' ethnicity when judging health

Baby fat? Doctors urged to weigh newborns' ethnicity when judging health

New Birthweight Curves (Gestational Age 23-41 wks)

Birthweight curves for newborns according to maternal ancestry

Canadian data suggests that infants born to parents of East Asian and South Asian ancestry may be of lower birth weight than those of White European decent. Using traditional newborn birthweight curves, some Canadian newborns of East Asian and South Asian ancestry may be misclassified as small for gestational age birthweight (SGA), while they are actually normal in birthweight if compared to other East Asian and South Asian infants.

http://www.stmichaelshospital.com/birthweights.php

Winter travel

In my last post, I mentioned traveling across the country with my little one.  Traveling in the winter is not as easy as it would be any other time of the year.  We thought that there may be an issue with air travel because of the change of pressure but learned from our doctor the real issue: colds, germs and RSV are next to impossible to avoid during air travel over the winter months.  We've all been there; trapped on a plane next to someone who keeps hacking or sneezing.  I rarely get sick but it almost always happens after a flight.  It's not a stretch to think that a preemie would stand no chance of avoiding a cold or worse in those circumstances. 

So we considered the alternatives: it's completely impractical to drive from Alberta to Ontario and not safe to keep your child in the car seat for any extended period of time.

And that's how we found ourselves traveling by train from Alberta to Ontario.  We got ourselves a 2 person cabin, which included a private bathroom. This allowed us to keep him in the cabin at all times, away from all the germs.  We cavi-wiped the cabin when we first arrived and he had no idea he was confined to such a small space for the duration of the trip. Rather than take turns eating in the dining car, we had room service for all our meals.  There are obvious downsides to train travel: departure is from Edmonton so added driving time, overall travel time, cost and comfort.  The upsides were that we had our own space and the food was good (always had vegetarian options available and they made my food dairy-free upon request).  The most important upside was that it gave us peace of mind that we were limiting his exposure on a much needed visit with family.

Via has 50% sales in down periods so if you keep your eyes open you may be able to get a good deal. Consider train travel www.viarail.ca/en/deals.     

RSV Season - no need to test my son's immune system just yet

We just returned from a trip across Canada with my son. Traveling with a preemie, especially during RSV season is stressful and can be risky. Preemies are at an increased risk for complications from a serious, pediatric illness called Respiratory Syncytial Virus or RSV. 

RSV is a virus that causes a respiratory tract infection. RSV is the most common cause of bronchiolitis and pneumonia and is the leading cause of viral death in children under the age of five. RSV is the number one reason for hospitalization of children under the age of one.

Preemies are at a high risk for catching RSV for a number of reasons, however it is largely because normal lung development is cut short.  Preemies have neither developed a normal immune response yet nor the lung capacity of full-term children. This makes it difficult for these infants to fight infections, and is why RSV can turn very serious very quickly. Serious cases of RSV can lead to hospitalization and, sadly, death for some infants. If you have spent any time in an NICU, you have surely heard the warnings from the doctors and nurses about the serious risk.  


There are several factors that increase the risk of serious RSV infection and hospitalization, including:

•                Preterm birth

•                Chronic lung disease

•                Congenital heart disease

•                Immunodeficiency

•                Exposure to second-hand smoke

•                Daycare attendance

•                Multiple birth

•                Family history of asthma

•                Birth within 6 months of the onset of RSV season

In Calgary this year, RSV season began in late November and is expected to last until April. It is very important to take precautions during this period.

Although RSV symptoms are similar to a cold and include: fever, runny nose, and coughing, more serious symptoms include wheezing, difficulty breathing, inability to eat, and apnea. The symptoms can develop quickly and preemies can get very sick in a short period.  

RSV is passed by sneezing, coughing, or by hands touching the nose or eyes and then coming into contact with another person or object. RSV can survive up to 6 hours on hands and up to 12 hours on surfaces.  Our physician strongly encouraged that we limit our son's exposure to public places where they can come into contact with people who might be sick, such as at malls, day cares, grocery stores, large family gatherings, especially when other children who might be sick are present. 

GOOD HANDWASHING IS VERY IMPORTANT TO MINIMIZE RISK

•                Require everyone who comes in contact with your child to wash their hands 

•                Keep your baby away from crowded places during RSV season

•                Limit exposure to people who are sick even if they are getting over a cold – don’t be afraid to tell friends and family that they can’t visit if they are sick

•                Keep your baby away from people who smoke

            One of the hardest things for parents of preemies is to explain to other parents why you are treating your baby differently.  People will make comments about how it is good to help your child develop immunities by exposing them to sick people.  In the case of a preemie, it simply isn't true. DO NOT BE AFRAID TO TELL FRIENDS AND FAMILY THAT THEY CAN'T VISIT IF THEY ARE SICK.  People will understand and waiting a few weeks, or even a few months to visit is not a long time in the lifetime of your child.  Your friends and family will understand.

If you would like additional information, please check out the following links:

http://www.lung.ca/diseases-maladies/a-z/rsv-vrs/index_e.php

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/pneumovirus-eng.php

http://preemies.about.com/od/preemiehealthproblems/a/RSVinPreemies.htm
https://myhealth.alberta.ca/health/pages/conditions.aspx?hwid=hw176517&

http://www.albertahealthservices.ca/rsvprogram.asp

Consider Probiotics

Premature babies are more likely to suffer from gas pains, transient lactase deficiency and colic because of their immature digestive systems.  Bio Gaia Probiotic Drops were referred to us as a preventative measure to reduce gas. The drops contain lactobacillus, a form of good bacteria that naturally occurs in our stomachs and aids digestion. You simply give your baby 5 drops a day, either in a bottle mixed with milk, or directly into their mouths. 

The product must remain refrigerated, and is not carried by all pharmacies so it is a good idea to call ahead. Ask your doctors whether they think it may help if you're having difficulties with your little one.

http://www.biogaia.com/consumer/facts-about-infant-colic

Helpful Sites

Helpful sites:

General information re Prematurity
www.marchofdimes.com

Preemie Growth Chart
www.medcalc.com/growth
www.adoptmed.org/storage/VLBW%20Premature%20Boys.pdf

Developmental Milestones for a Newborn
http://tumblon.com/milestones/age/newborn

IVH
www.aboutkidshealth.ca/en/resourcecentres/prematurebabies/aboutprematurebabies/brainandbehaviour/pages/intraventricular-hemorrhage-ivh.aspx

Sweet Ginger Photography

Because it was RSV season, we felt particularly nervous about taking Elie to the mall or a studio to get his photos taken.  As soon as we got the news that Elie would be coming home soon, we arranged for Virginia of Sweet Ginger Photography to come to our house.  She didn't balk when we explained to her that everyone needed to use Microsan and that the session could only proceed if she was germ-free.  She spent 3 hours with us and was so patient with our little man.  This photo, the blog background and my profile photo are examples of the beautiful photographs she has taken of our son.  She has worked with preemies before and knows how to capture the excitement of parents bringing their son or daughter home after weeks or months of wait.  We are so glad that we got the photos because he is already so much bigger and it's hard to remember how small he once was.

Thanks Virginia @  www.sweetgingerphotography.com

2012 Sport Chek Mother's Day Run & Walk in support of NICU

Please participate by walking or running or sponsor someone you know.  Not only is it a fun and amazing event with thousands of people out for a good cause, but the proceeds for this event will go specifically to purchasing life-saving equipment for the NICU.

http://www.mdrunandwalk.com/index.php?option=com_content&view=article&id=26&Itemid=37

"It's okay to need support"

Within the first week of having my son, it sank in how different his arrival was from what most new mothers experience.  Worry and concern had firmly set in and I went back and forth between wanting to tell people how I felt to wanting to hide it so that people wouldn't think anything was wrong with him.  A friend of mine is an ob/gyn surgeon and because she worked at FMC she was one of the few people allowed to visit while I was in the hospital recovering from delivery. She said something that stuck with me in the first few weeks we were in the NICU, when we felt most afraid.  She said quite plainly, "it's okay to need support, that's all they're doing is giving him a little extra support until he catches up".

Several weeks later, another mom said something to me along the same vein.  This mother was in the NICU for the second time; she suffered from preeclampsia and had had spent more than 100 days in the NICU with her first child and was approaching 3 months with her second.  She explained to me that she recoiled every time someone suggested that her children were sick. In her eyes, they weren't sick they were just early and needed some time to develop before coming home.  

Over the next 7 weeks in the NICU I learned that there were so many people willing to help provide my son with that love and support.  The neonatologists, nurses, residents, dieticians, nurse practitioners, respiratory technicians, lactation consultants, unit clerks and other staff all played a role in supporting him as he fed and grew.  

No one wants their child to start off life as a sick child.  I realized that these two friends were right; the people around me took their cues on how to treat my son from how I viewed/described the situation.  From then on when people asked me how he was doing I answered that he was just a little tiny and early but doing well.  And he continues to do well - at 9 weeks adjusted he smiles, coos, lifts his head, holds our gaze and is an impressive 12 lbs.  All he really needed was a little love and support along the way.

Preterm Labour

I had a low risk pregnancy but went into labour spontaneously at 29 weeks, 4 days.  At the time I had no information about the complications associated with preterm labour and had no idea why it was happening and whether I had done anything to bring this upon myself.  I learned that there was not a lot I could have done to prevent it, and it wasn't my fault (though it took me awhile to let go of that guilty voice in my head).  I've been told by many other parents that this is just the beginning of the guilt I will feel at every turn as a parent!

The Society of Obstetricians and Gynaecologists of Canada is comprised of over 3000 professional members, including gynaecologists, obstetricians, family physicians, nurses, midwives and allied health professionals.  The following is an article on Preterm Labour found on the SOGC website at http://www.sogc.org/health/pregnancy-preterm_e.asp 

Preterm Labour

Not everyone understands how important it is to carry a baby to full term. Some women hope for a premature baby, thinking a small baby may be easier to deliver.

In fact, premature labour is one of the most common problems in pregnancy and it is the cause of 75 percent of all newborn deaths in babies born without birth defects. Premature babies are more delicate and can have lifelong problems related to their prematurity. In general, the more premature a baby is, the more severe the problems. Babies born before the 25th week usually do not survive without problems.

It is important to know early whether premature labour is occurring, as it sometimes can be stopped or delayed. This can provide time to give medicine that can help the baby, and to treat conditions causing premature labour.

What causes premature labour?

Why some women develop premature labour, and others don’t, is not well known. What we do know is that about half of all premature labours begin for unknown reasons to women whose pregnancies were otherwise normal. However, certain things seem to increase a woman’s chances of going into early labour.

What you do during your pregnancy can help you carry your baby longer, and give him a better start. Research has shown that the more women know about the signs and risks of premature labour, the lower the rate of premature births.

In France, one long-term study showed a large reduction in overall prematurity rate when the following steps were taken:

• There was public education about preterm labour and the importance of healthy full term babies to society as a whole.
• Special seats on buses and special parking places were set aside for pregnant women.
• Pregnant women were encouraged to keep their own pregnancy record.

These are some of the risk factors for premature labour, and how the risk can be reduced:

Smoking - It is best not to smoke during pregnancy. You can still benefit your baby if you quit smoking before you reach 32 weeks.

Working too hard - Working long hours, doing strenuous kinds of work and being tired all the time can lead to a preterm birth.

Physical and emotional abuse - When someone hurts you, they can also hurt your unborn baby. Even emotional abuse can lead to a preterm birth by significantly raising your stress levels. Please seek the help you need by calling a family crisis centre in your area.

Incompetent cervix – a rare condition in which the cervix dilates (opens) early and is associated with premature labour. This can sometimes be diagnosed during a vaginal examination or by measuring the size of the cervix during an ultrasound. Sometimes this can be treated by sewing the cervix closed with a “drawstring” stitch and removing the sutures when the baby is full term.

Fibroids in and/or on your uterus can cause it to be misshapen. If fibroids large enough to deform the uterus are detected before pregnancy, they may be removed. Small fibroids usually don’t cause problems during pregnancy.

Bleeding during second trimester - A small amount of bleeding can occur if the placenta begins to separate a bit from the lining of the uterus before labour starts. Each case of bleeding should be treated separately and may be treated differently depending on the cause. Always notify your health care provider about bleeding.

Abdominal surgery during pregnancy - Sometimes abdominal surgery is needed when a woman is pregnant (for example, for appendicitis). Surgery that is wanted but not essential (elective) should be avoided until after the baby is born.

Common infections in the mother are vaginal, cervical, kidney or bladder infections. You may have a bladder or kidney infection if you have pain when you urinate, if you have to go often, and when you do only a small amount of urine comes out. You may have an infection in your vagina or cervix if you notice an unusual vaginal discharge, have pain in your pelvis or groin area, or a fever. Notify your doctor.

An underweight mother - Treatment depends on the cause of the problem. Sometimes this problem is helped by eating healthy, good food on a regular basis. Talk to your health care provider if you are underweight and having problems.

Placenta previa – a condition in which the placenta implanted and grew over the opening of the cervix (where the baby must come out). This can lead to hemorrhaging during labour. This problem is usually found during routine ultrasound testing. The mother is often confined to bed for the last few weeks of pregnancy and the baby is usually delivered by caesarean section before labour has a chance to begin.

Premature rupture of membranes – the sac of amniotic fluid breaks or leaks before your baby reaches full term. Some studies link this to infections in the uterus, but further research needs to be done. If your membranes rupture early, treatment depends on how much amniotic fluid is lost and how close to your due date you are. Notify your doctor, or health care provider.

Gestational hypertension (high blood pressure caused by pregnancy) – is treatable in various ways depending on the severity.

Chronic illness in the mother. Some illnesses (diabetes, high blood pressure) may become out of control during the pregnancy, and in some situations the only way to stop the worsening condition is to deliver the baby. Sometimes the labour will begin too early on its own, and in other cases, the labour needs to be brought on (induced).

What you can do to prevent premature labour

There are other basic things which you can do in an effort to try to prevent your baby from being born too soon.

Quit smoking: Try to understand why you smoke, and seek help to learn other ways of dealing with these issues. Ask around in your community about “Quit Smoking” programs. Ask your doctor about programs to help you quit.

Eat properly: Talk to a registered dietitian about your eating habits. Plan your meals around the basic food groups and avoid junk food. Drink plenty of milk.

Get help if you need it: You have a right to feel safe. If you are being abused, call your local women's shelter and ask where you can go for help.

Get plenty of rest: Plan ahead to be sure a certain part of your day will be set aside for you to rest. Don't feel guilty for resting. It is very important during pregnancy.

Learn ways to reduce stress: Talk to people you trust about how you feel. Learn relaxation techniques such as meditation and self-massage to reduce your stress. Consider yoga.

Avoid strenuous work

Avoid overexertion when exercising during pregnancy: Even though you are physically fit, it is important not to increase your workout intensity during certain times of your pregnancy.

Learn to recognize the signs of premature labour: Prenatal classes through your hospital or community are an excellent way to learn. Talk to your doctor.

Learn the steps to take if you think you are in premature labour: Talk to your doctor about what you should do. Write down the phone numbers to call and what your doctor wants you to do if you go into premature labour

Visit your doctor regularly during pregnancy: This is one of the most important things you can do to prevent premature labour because it gives your doctor a chance to find or prevent problems, which may cause your baby to be born early.

Dairy-free Diet

On week 3 of his stay at the NICU, we went through a NEC scare and the doctors put me on a dairy-free diet. Like most people, I wrongly believed that my diet contained very little dairy but I hadn't counted on how many things contained soy which was also to be avoided.  I learned quickly to read food labels carefully and ask questions about ingredients when ordering in restaurants.

Here is a short list of obvious and not so obvious milk products:

Artificial butter flavor, Butter, Butter fat, Buttermilk, Butter oil, Casein,  Cheese, Cottage cheese, Cream, Curds, Custard, Ghee, Goat’s milk, Half & half, Hydrolysates (casein, milk protein, protein, whey, whey protein), Kefir, Koumiss, Lactalbumin, Lactalbumin phosphate, Lactoglobulin, Lactose, Lactulose, Milk, Nougat, Sour cream,  Sour milk solids, Whey, Yogurt

The following foods MAY contain milk protein:

Chocolate, Flavourings (natural or artificial), High protein flour, Hot Dogs, Deli Meat, Margarine, Sausage

It is important to check how foods have been prepared when you eat in restaurants.  Butter is used to add flavour to pretty much everything so you need to ask about how food has been prepared.  It is easy to ask that the chef uses oil instead.  Omelettes and scrambled eggs often have milk added so beware.

Our doctor advised us that goat and sheep milk should also be avoided as they contain proteins similar to cow's milk protein.  It is important to ensure you take adequate calcium supplements to avoid rickets for your baby and to protect your own calcium stores.  

The greatest problem came with trying to eat food "on the run". Here is a short list of dairy-free friendly restaurants.  Please add to the list if you can.

Coffee (with cream/milk alternatives)
Good Earth - almond milk
Beano - almond milk

Fish
Trawlers panfried

Chicken
Swiss Chalet chicken meal including dipping sauce

Bread
Lakeview Bakery Spelt bread

Charcuterie (bread & meats)
Charcut

While on this diet, it is very important to supplement calcium with 1000mg of calcium/magnesium.  It is not enough to rely on TUMS to supplement the missing dietary calcium.

Gift funds new neonatal beds at Children's Hospital

lhttp://www.cbc.ca/news/canada/calgary/story/2012/01/25/calgary-intensive-care-children.html

How much does your baby weigh?

People understand numbers, so it's not surprising that the first question my friends and colleagues asked was "how much does your son weigh?"... I dreaded that question.  No matter how many ounces he had gained, or how well he was feeding, people always seemed shocked when I answered the question.

He had hit a low of 2 lbs 11 oz when he battled an infection so on the day he hit 4 lbs I felt so much joy and happiness.  He had come so far and was finally gaining steadily.  On that day I left the NICU and decided to stop by work to catch up with my colleagues.  When the question came, I answered "4 lbs" with such pride.  Their reactions were uniform; they couldn't believe how small he was and how slowly (in their eyes) he was gaining weight.  In an instant all the happiness I felt was replaced with fear and worry and a bit of shame that I was having so many problems with being a mom.  It took me several months, almost the entire duration of his stay in the NICU to stop listening.  I stopped listening to the people who didn't know any better and sometimes didn't even answer the question directly but instead listed off all the progress my son had made and his accomplishments.  No one meant any harm they just did not appreciate the anxiety new parents of preemies go through when faced with that question.  I also learned to surround myself with supportive friends and family who did nothing but cheer on every day he was alive and every ounce my son gained.   Somehow they knew that's what we needed and gave me strength during such an overwhelming time.

Similarly, I now try not to give airtime in my head to comments by strangers who ask "how old is your baby" or who seem to dismiss the concept of adjusted age when I explain it to them.

To all of those special people in my life who love and support my little guy, thank you.    

Welcome from an NICU alum

I recently stumbled across a blog created for Sunnybrook NICU families and was inspired to create something similar for families with babies in any one of the Calgary NICUs.

It is hard to explain to someone the worries and challenges that parents of preemies encounter during their stays and after their escape from the NICU.  I found trying to obtain relevant information frustrating and  often spent hours on the internet searching for answers or anecdotal information after having spent very long days at my son's bedside.  It was a struggle to identify recent or local information and most websites were of little use.

During our time in the NICU (first at FMC, then at Rockyview), we learned that Calgary has the highest preterm delivery rates in the country.  This blog is intended to be a way for those many parents to support each other, share stories and exchange information.  I am hopeful that it makes the overwhelming process of having a preemie in a Calgary NICU a little less lonely.  Please post away!

Jacquie