After sharing the story of Iris’s sudden birth at 30 weeks, in discussion about my adjustment to life in the NICU, I was told by many that I’d have to “be my own advocate”. “Well that will be no problem!” I thought. What I didn’t expect was that “being my own advocate” would mean being reduced to an uncontrollable onslaught of tears as I asserted my right to hold my completely stable, healthy, albeit 3 lb daughter while nurses tried to take her away from me so that she could spend even more time in her isolate.
First of all, for anyone not familiar with the term, kangaroo care, also referred to as skin to skin care, is simply that. You hold your bare chested baby against your own bare chest in an upright position between your breasts. Current research has proven this simple method of care maintains the babies body temperature, facilitates bonding and breastfeeding, increases the mothers milk production, and can even increase weight gain and alertness. It is proven to be a safe alternative to isolates for stable low birthweight infants and is recommended by developmental care specialists who, “insist that parents should be at the center of the NICU, allowed at their babies side twenty-four hours a day, and treated by medical staff not as guests but as the primary caregivers for their babies.” Our NICU claims to encourage this widespread method of care.
At the onset of her NICU stay Iris was connected to a CPAP and IVs, making it more complicated for us to hold her, preventing us from bonding with her as often as we would have liked. We understood the reasons for this and accepted it. After those hinderances were removed we had a wonderful nurse over the weekend whose approach to care finally made us feel like the primary caregivers for our daughter. She dug through a storage area to find me a comfortable chair for kangaroo care, showed us the many ways we could be involved in her care and gave me the confidence to handle my daughter without the help of nurses. I established a kangaroo care routine, scheduling my pumping sessions around her care and feedings. I would place her in her isolate, pump and eat, come back and take her temperature, change her diaper, and then hold her during her feed for two to two and a half hours until it was time for me to pump again. Over the next four days I became increasingly comfortable and content with the NICU experience. I was slightly frustrated by the lack of continuity in her care; each day she has a different nurse and each nurse has slightly different opinions and ways of doing things. Every morning was a reintroduction, but those confusions were small things. Overall each nurse seemed happy to see me, asked what my plan was for the day, said that sounded great, commented that they knew I was there every day and comfortable with things, and made me feel the way a mother should feel in the NICU.
Thursday, the two week anniversary of her birth, Iris had a nurse who, it quickly became clear, was not comfortable with my level of involvement in her care. After my first pumping session, as I picked her up to get into position for our second stretch of kangaroo care, she told me I needed to leave her in the isolate for this feed because she had a good temperature and she didn’t want to compromise that. Not only have I read enough to know that our skin to skin time does a perfect job of keeping her warm, every nurse I had that week commented on how warm, comfortable and restful she was on me. At this point, with no medically indicated reason to keep her from being held, no one was going to stop me from holding my baby in the limited six hours a day I have to be with her. What I didn’t expect was how emotional I would get as I explained that I do this routine everyday, it is never a problem, and I will continue to practice kangaroo care until a doctor provides me with evidence that it is hindering her growth and development. No one will ever be able to convince me that it is better for my baby to spend all of her time in an isolate. Unfortunately, this is the belief of many nurses who still subscribe to philosophies of traditional methods of care.
The next morning I was greeted by a social worker who listened to my concerns. The nurse that day proved to be even more difficult than the last, and next I was speaking to the manager of the unit, and a doctor. Suddenly everyone was obsessing over her temperature regulation, asserting outdated and disproven opinions about the superiority of the isolate. My baby grows between a half ounce to an ounce a day, exactly what is expected at this stage. My care has been consistent every day, on days she gained more and days she gained less, I did the same thing, making it completely illogical to claim that I am interfering with her growth. Essentially, we are talking about four to six hours out of a twenty four hour day spent being held by her mother. What is a complete non-issue, was suddenly becoming a very large issue. I spent the entire morning crying as I held my baby, debating with people who were trying to limit my kangaroo time to one hour a day. The nurse came over in the middle of Iris’s feed and attempted to take her from me, despite the fact that the importance of not moving her during or for a half hour after her feed to prevent reflux has been stressed to me by every previous nurse. The temperature probe was reading a perfect temperature, better than it had in her isolate, they dismissed this as the blanket warming it so I asked them to take her temperature, it was 98.6. No one succeeded in taking away my baby, and my husband left work as soon as I was able to call him and sat by my side for support. In an attempt to resolve our issue this nurse actually said to me, “I will do things your way for the rest of the day, even if it means your baby will grow more slowly, if thats what you want thats fine with me.” Studies show Kangaroo care increases weight gain in low birth weight babies, and in no way is this method just “my way” as much as I’d love to take credit.
The next day we came in and were greeted by one of the nurses I had previously that week, I resumed my usual routine with no controversy. The same followed for the days after, reassuring me that this was a non-issue that was made an issue by a couple of nurses who are not comfortable with parents in their workspace. Whether the absence of other parents in the unit is a consequence or part cause of this I’m still not sure. I have never seen any other parents in this NICU on a regular basis, and have never seen anyone else practicing kangaroo care, despite the fact that it is a common and recommended practice for premature infants.
Did you practice kangaroo care with your newborn or preemie? Anyone else find that while their NICU claimed to encourage kangaroo care and breastfeeding, its practices often proved otherwise?