WHAT TO DO

After having a baby, your emotions can range from ecstasy to exhaustion, and if your baby is born sick or arrives earlier than expected, this can add to the pressure. Ruth Powys of premature baby charity BLISS offers some practical advice.

First impressions

The neonatal unit is likely to be different from almost any other place you have been, and you may have just experienced one of the most traumatic episodes of your life. The room is full of monitors, high-tech equipment and the frequent sound of alarms.

To start with, the staff may do most of the work and it is easy to begin to feel as if you are not needed. This is not true. The staff will encourage you to become involved and understand what is happening to your baby, and as your child grows stronger, you should be able to do more and more.

Looking different

Many premature babies have a fine covering of dark hair. Doctors call this lanugo. It is normal and soon goes away.

If your baby is very premature, he or she may only be the length of your hand and may well sleep almost 20 hours each day. The skin could seem waxy at first and may also be transparent because there is little or no fat beneath it. This means that you can see a fine network of blood vessels.

The skull bones of premature babies are quite soft. A soft pillow or a water pillow may prevent the head developing a flattened shape. By the time the baby is mature enough to go home, the skull bones will have hardened up. Pillows should not be used for any baby at home as it can be unsafe.

By the time your baby reaches the date that he or she was expected to be born, he or she is unlikely to look very different from a full-term baby of the same weight.

Caring touch

Your baby needs as much rest as possible but it is important that he or she gets to know you, your voice and your smell.

Try not to be overwhelmed when you see your baby surrounded by equipment. Keep focused on him or her as much as possible. Some medical procedures can cause your baby discomfort, and this needs to be balanced by providing a positive, reassuring touch.

How to do this may depend on a number of things, but the most important is how stressed you baby is on any particular day. But there will rarely be a day when you can't hold your baby's hand.

Your baby may be more comfortable left lying in the incubator and at this stage will enjoy a still hold more than stroking or patting, which can be over-stimulating.

Place one hand firmly but gently on your baby's head and the other hand on your baby's middle. If possible, allow your hands to come together in the middle. This containment holding can help your baby feel secure, relaxed and loved.

If your baby is well enough you may be able to lift him or her out of the incubator to snuggle gently on your chest. It is best if the baby can lie directly on your skin. Kangaroo care is often the first time parents feel that they are really having contact with their baby and it can be a great way of establishing a lasting attachment. This contact can have a very positive effect on the baby's health.

A bigger role

Over time, care staff start to show parents how to do some of the routine tasks such as changing a nappy. This is a good way to take an active role in the day-to-day care.

Feeding your baby is a superb way of helping care for him or her, particularly as it is the time when premature babies are most likely to be awake.

At first, nurses may be very reluctant to wash your baby even with warm water, because it could cool the baby down, which is something that they want to avoid. Once your baby has grown a little and is stronger, you may be able to join in with the fun of bathing. It won't take long before you feel confident to do this with little or no help from staff.

Understanding medical procedures

You will be in a better position to join in with looking after your baby once you understand what the doctors and nurses are doing. Feel free to ask questions. You may want to keep a small notebook to jot down any questions as they come to your mind. You may also find it helpful to write down the answers. It is better for you to be satisfied and happy than to go away with unnecessary worries. Some doctors are happy for you to tape record appointments so that you can listen again to what they said about your baby's progress and think it through.

Family support

While the mother and baby tend to get the majority of the attention and concern, fathers are still emotionally involved and on top of this may often have to look after other family members as well as keep going to work. Family and friends may also be worried about the baby and are often anxious to know how to help without getting in the way.

Other parents who have been through the experience say that friends dropping round with a ready-cooked meal can be a real help, as can looking after toddlers or picking up children form school. This can help you to spend some unhurried time in the hospital, supporting mum and getting to know your new baby.

Fathers can join in with caring for the baby in the same way as mothers, including feeding, bathing, nappy changing, kangaroo care and containment holding. This can help them get to know each other, Couples may also both benefit from simple things like going to the canteen, having a cup of tea and discussing how things are going.

Going home

Planning to bring your baby home can cause great anxiety as well as relief. During the time that you and your baby have been on the unit you may have grown used to a high level of support and advice. At home you will be much more on your own.

But even at home there are health services available to help. A health visitor should be able to give support along with your local GP. Some areas of Britain have specialised neonatal outreach teams or community-based paediatric homecare teams who can also provide specialist support. Make sure you know about all the services that are available before you leave the hospital.

Long-term

Your baby may have problems that continue for some months or years. Babies who have spent a long time on a ventilator can often become wheezy when they get a cold or virus that affects their chests. Others may have later learning or movement difficulties.

Make sure that care staff at nurseries, teachers at schools and any health professional you meet are fully aware that your child had a premature birth or special needs after birth. This information should help them make a more accurate assessment of any problem.

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