Possible 36 week delivery, hospital has no NICU

[KatiLB]

I'm looking for input from both L&D and NICU nurses. I'm currently 34 weeks pregnant with my 3rd, and home on strict bedrest due to contractions. Had two trips to L&D in the last few weeks with frequent Braxton Hicks (>15/hr the first time, >20/hr the second). The first time I was sent home after a negative fFN, the second after 2L of LR and 2 doses of terb. I should add I have had two c-sections, the first vertical d/t spina bifida/hydrocephalus in my son. My second son was born via emergency c-section at exactly 37 weeks after they were unable to stop my contractions with terb and he started having decels. The hospital I will be delivering at has no NICU, although they can deal with minor complications, I'm just not sure what (will be asking at my next appt). My husband and I have talked about this, and would still like to deliver at my original hospital, if my little man (yes, ANOTHER boy) gets transferred, my husband will go with him. I also cannot take Procardia d/t low BP (often 80s/40s at rest normally). I'm sorry this is so long, just wanted to make sure you had all the facts and background I could give you. I'm just wanting any input you all can give me on what to expect if I go before 37 weeks or if baby needs transferred. I know all babies are different. I'm not looking for sugar coating. I need facts on what you have encountered in your careers. My doc seems comfortable with a 36 week delivery if it happens. What are your thoughts? I'm an Oncology nurse, don't know nothing 'bout no babies!

[PinkNBlue, BSN, RN]

Awww best wishes to you and your new little bundle. I've seen 35-36 weekers do awesome and 41 weekers need more help. It all depends on the situation and how well baby tolerates everything. Best wishes and prayers you make it to your section!

[asher315]

Check with your pediatrician. They would know the hospital and staff. Best wishes to you and your family!

[sadiemae1123]

A Level 1 Nursery should be qualified to take care of a baby over 35 weeks as long as there are no major complications such as congenital defects, severe respiratory distress, etc. Usually they are capable of providing short term oxygen therapy if the baby is transitional and IV therapy if needed.

This is a conversation you should have with your pediatrician and the manager of the newborn nursery. You should be aware of what training the nurses have, what their comfort level with caring for a late preterm baby is, policies and protocols for babies born with any problems, and how transfers are handled.

Remember it's not just matter of whether your OB and pediatrician are comfortable with taking care of a late preterm baby, but also how well trained, equipped and staffed the nursery is as well.

[IrishIzCPNP, MSN, RN, APRN, NP]

Well, like I said, every baby is different. Some have no problems, some do. Girls do better than boys. White babies do worse than AA or Latino babies. Every late preterm baby needs additional lactation support, including pumping in addition to breastfeeding until the baby reaches at least 40 weeks adjusted age.

Not every late preterm needs additional support and pumping. I wouldn't say that at all. I wouldn't say it as an IBLCLC or as a parent of 4 born at 36 weeks or less and none needing any extra support (including pumping) for breastfeeding.

[klone, MSN, RN]

Research has shown that an infant doesn't achieve full suck strength until term. The infant may appear to latch and suck well, but milk extraction at 36 weeks is not what it is at 40 week, thus women risk losing milk supply. The recommendation is that women of late preterm infants should pump after feedings until around 40 weeks adjusted age, regardless of whether it appears if the infant is nursing well. You were fortunate that you didn't have any problems with your infants, but that doesn't change what the recommendation is for lactation management with late preterm infants.

[IrishIzCPNP, MSN, RN, APRN, NP]

Research has shown that an infant doesn't achieve full suck strength until term. The infant may appear to latch and suck well, but milk extraction at 36 weeks is not what it is at 40 week, thus women risk losing milk supply. The recommendation is that women of late preterm infants should pump after feedings until around 40 weeks adjusted age, regardless of whether it appears if the infant is nursing well. You were fortunate that you didn't have any problems with your infants, but that doesn't change what the recommendation is for lactation management with late preterm infants.

Who's recommendation is that?

[traumaRUs, MSN, APRN]

You have gotten some good advice....we advise you to discuss this further with your provider