Mom bonding question

[super mom]

I know this place is for nurses but I have been trying to walk in your shoes this week and see what you may be thinking about a family member.

My niece has a newborn in NICU. The baby was born at 37 weeks (&5 days) and almost eight pounds. But she was born with gastroschisis. She required only one surgery to return the organs and close the opening. Monday will be the fourth week of her stay. Because she refused the bottle her stomach tube was re-inserted just before the three week point and a day after the removial. They allowed the mother to breast feed for the first time yesterday but are only suggesting two tries a day. The Mother - a young, single, 20 year old. Is not consistent with her visits to the hospital. She will skip days and not ask me for rides or help getting there but complains about the 30 mile all interstate drive. While I was there yesterday, mom had a great tan and admitted to being by the pool daily. To top that off she left town for the weekend and will not be visiting the baby.

Leading to my question - the mom thinks that the baby will be coming home Tuesday. I don't see them releasing her with a tube and not taking a bottle or breast to someone who appears inconsistent in the ability to care for her. I know the breast milk will dry up over the weekend and that she didn't not leave enough expressed milk at the hospital last night to make the night.

How is this behavior viewed by the NICU staff?

Does it weight on the release of the baby as it should?

I am prepared to be very honest with her when and if the release does not happen.

[Jolie, BSN]

Thank you for your concern. It is most certainly justified, and I'm sure the staff shares it.

Most NICUs have a social worker on staff who can help to address issues such as infrequent /inconsistent visiting, lack of preparation for discharge, teaching needs, etc. Putting on my amateur psychologist hat, I would guess that your niece is frustrated by the fact that she didn't have a "Gerber" baby to take home and show off to her friends. She is probably tiring of the drudgery of parenting a NICU baby, which concerns me, because it won't be any easier once the baby comes home.

I think it is time for frank discussions about the requirements for discharge, in terms of parent teaching, supplies and equipment, schedule of doctor's visits, 24-hour care for the infant by a competent, adult care-giver (Meaning that her young friends will NOT be suitable baby-sitters.), etc. I would be VERY concerned for the baby's well-being if she lives alone and plans to take this baby home by herself. Is the father involved? Will your niece be living with her parents?

Please speak with your niece and let her know that you would like to help her prepare for discharge by making a family appointment with the social worker. It is unlikely that the unit staff can discuss much with you (due to HIPAA) unless your niece gives her consent, or is present.

Again, thank you and God Bless!

[prmenrs, RN]

My thought is that she's in denial about how sick the baby is, maybe guilty that the baby has problems (which are NOT her fault, make sure she knows that!). Some parents (no matter their age) go thru a grief process about not getting the baby they thought they were getting.

No matter which of the above (or none of them) apply to her, she's "escaping" by going to the pool, not visiting, etc.

If you have any input, suggest she have an "overnight" where she assumes most of the care for the baby. This will give her a more realistic idea of what she's facing. Hopefully, you and the rest of the family can provide support and "back-up" w/o taking over--no matter how tempting. And, also hopefully, she will accept the help. No mom should try to do it all by herself.

There should be some follow-up (PHN?) once the baby is home, depending on the system where you live. And there should be criteria for when the baby will be d/c'd: taking and tolerating enough feedings to gain weight, mom able to care for baby would be the ones I can think of.

If there is a "step-down" or Level 2 nursery in a hospital closer to home, transferring the baby there before d/c might be an option.

WARNING: babies who have gut problems tend to be rather irritable. A really good baby gift is a swing. I highly recommend these CDs: http://www.amazon.com/Stops-Crying-Heartbeat-Musical-Therapy/dp/B00003TFYP/ref=rsl_mainw_dpl/104-6477764-9340750?ie=UTF8&m=ATVPDKIKX0DER

[super mom]

The father is around but I see another issue. He works a 12 hour day and she is leaving him in the dark about the baby's progress. I took them to dinner and brought up the IV being in the foot and he had no idea that one needed to be reinserted. (She got an infection) So he is not making visits either.

Her parents are not to well involved. Yes, she already has a young friend set up to watch the baby three days a week.

It's funny that the night visit was suggested. I suggested it recently only because she felt the night nurse was giving her a hard time. I told her to stay the night and use the sleep room to over see the nurse and the baby's care. It hasn't happened. But that would have been a great way for her to see that a baby needs 24 hour care. My big saying to her is that even a healthy baby needs 24 hour adult care.

Is this a common issue with young mothers?

[justme1972]

I'm going to share something with you that I can't believe that I'm putting on this board, b/c it's something that only my husband knows about.

When my twins were born, both preemies, I was extremely traumatized by the entire event. You have the horror of a non-perfect baby along with post-partum depression and to me, that is a nasty combination to deal with emotionally.

I visited them alot when I was in the hospital, but when the day came to leave them for the first night, as we were driving away from the hospital I looked at my husband and said, "You know, I almost feel like I could not go back to the hospital ever again and be ok with that."

He looked at me like I was crazy. I look back on that now, and I probably should have been put in the funny farm.

As I look back, everything that I was experiencing was on an unconscious level, I was void of all emotion that everyone else sees. Going to the hospital was a chore, pumping was a chore, I went every day, but didn't want to go every day. I looked at other babies that were new and would go to my car and break down crying because I didn't have my babies (and I had two other friends that had babies at the same time that gave birth after me, but got their babies home before I did).

I started to feel like my babies lived at the hospital, but they weren't mine. I did not feel any bonding whatsoever...it was like someone told me they were mine but I didn't feel like I had just given birth. The feeling is so difficult to explain.

I envied watching other mothers cover their babies with kisses, and all I could think of was if my children were even going to live.

Looking back, and no healthcare professional told me this, this is just my opinion. I think the C-section took away my bonding period, and I now firmly believe in that "window" of opportunity as I my kids were almost 2 days old before I even got to see them...there was no joy in my birth process, while we wanted healthy babies, it went from wanting a healthy babies to just babies that were alive....it is a drastic change of priority.

You never, ever expect to leave that hospital without your child/children.

It took me almost a year before I felt like a Mommy, a real Mommy.

Keep in mind...I did ALL of this with a huge amount of support and a loving family, and still felt this way....my point is that your neice needs a huge amount of intervention...is there someone else in the family that can take them both in for awhile to make sure the baby is attended to properly.

Every mother knows, but only when you get the babies home, that hearing a baby cry is like claws down a chalkboard, when there is sleep deprivation like nothing else you have ever experienced. I think that it's when it goes on and on with no support is when mothers "snap" and hurt their children, because they are no longer thinking normally.

Sorry for the book...this is just my experience. I'll be praying for your neice's baby.

[DC3RN]

I do hope the nurses are trying to encourage the mom to visit more and feel welcome there. I am lucky to work in an NICU that has family centered care and the parents can room in with their child and participate in cares as much as they can. But we do still have similar situtations to this one. Is there a social worker for the unit that will talk with her and try to uncover what the problem is. Maybe she is scared or in denial or whatever, there needs to be an intervention for the babie's sake.

It is hard enough on a young mother to take a healthy newborn home. Is there a young parents network type of group you can contact. I hope you can help her, I know this puts alot on your shoulders but from your letter it seems your are the only one seeing all sides of the situtation. Do it for the baby, She needs a gaurdian angel. Good Luck

[super mom]

Thank you so very much. I'm glad I don't feel like I was seeing something that really wasn't there. I talked to her yesterday and the hospital has contacted her about meeting with them and discussing what needs to happen before the baby goes home. Maybe this is where the social worker comes in. She is very blessed to be in a great hospital.

When I go up there I am with my two boys (3 & 7). The boys have been playing with two other children their ages and I get to take quick visits with the baby. To relieve the other parents (of the boys mine play with) and the grandmother they bring along, I have been reading Treasure Island aloud to them in the family room. I could easily entertain all four boys and give my niece a ride. I just keep making the offer and hopefully after this talk she will accept. As I always have, I will stand by her. Even when she gets that baby home and calls me at 2AM. It is all for that new life; that beautiful innocent miracle.

Thanks again!