Grieving and coping after the premature birth of your baby

I just found an excellent article online here: http://www.preemie-l.org/ALEXIs21.html

This article really mirrors my own experience of worrying about my emotional responses to having a premature baby.  It has taken me a long time to figure out what was going on, and to move forward and feel that I was healing.   I wish I’d found this a long time ago!

Breastmilk, formula and mother guilt

I keep seeing this issue come up for premmie mums. You’ve expressed for your baby while they are in the NICU (and often longer) as much as you could, you’ve given breastfeeding your best shot, but at some point despite all your best efforts it just doesn’t work out, you can’t keep your milk flowing and it feels like the end of the world.

You are not alone in feeling this way.

First, if you’ve expressed milk for your child while they were in hospital, woken up in the middle of the night at home to attach yourself to a breastpump far away from the child you want to be holding, and endured all the dairy cow comparisons, you are a legend. You have given your child the most amazing gift, one which has made the awful hospital journey that much easier for them to negotiate. You’ve dealt with stress, grief, fear and everything else on the emotional roller coaster and still delivered the elixir of life. As time passes, I hope you will look back on this achievement, as I do, with considerable pride.

If you’ve managed to establish breastfeeding, you are a champion - and so is your prem! It’s not easy trying to suck when you’re on CPAP or have an NG tube in the way. You might have had a prem with a weak suck, or who needed the help of a nipple shield, or other assistance. It may have been a battle getting nurses to stop tube feeding or topping up while you’re trying to move to all suck feeds. It’s nothing like the pictures in the hospital of chubby full term babies instinctively suckling within hours of their birth. Yet your persistence has been rewarded by the amazing feeling of your child connecting with you in one of the most powerful maternal bonding experiences around. This moment may be fleeting but it is definitely one to treasure.

Then things go pear-shaped. Your baby isn’t gaining weight, the stresses and strains of the whole prem experience lead to supply issues, you just can’t bear to keep expressing after everything you’ve been through. Or maybe you expressed or breastfed for months and months after coming home - but you wanted to keep going for longer, and it just isn’t working out. You’ve searched the internet for every possible means to increase your milk supply, you’ve been on prescription drugs but even they don’t help, and despite everything the pro breastfeeding lobby says (and you consider yourself a pro breastfeeding mother) sometimes mothers don’t produce enough milk to keep both baby AND mother healthy. Because ultimately your mental health is just as important as your baby’s physical health - and sometimes this gets overlooked. I was on the verge of serious postnatal depression because I was so worried about Talia’s lack of growth and my inability to produce more milk for her, when I desperately wanted to keep breastfeeding.

Then comes the awful moment, the time you had always thought you could avoid - when you have to go and buy a tin of formula. For me this came when Talia was about 6 months old, 3 months corrected. Personally I found this step so horrible that I looked at tins many times, picked them up and read them but couldn’t put them in my trolley. My mother (who was hugely supportive of my breastfeeding goals, and very impressed with the resources available to help me, such as the Breastfeeding Centre etc) reminded me gently that I had gone onto formula at 6 weeks of age during the 1970s when breastfeeding levels were at an all time low and support for mothers to breastfeed was minimal - and I’d turned out OK, and no-one could tell whether I’d been breastfed or not.

Eventually it was my sensible GP (who is a mother herself and had done all she could to help me by giving me a 6 month prescription of motilium) who asked me to consider making the move, because she could see I was digging a big hole for myself psychologically, and didn’t think depression would benefit either Talia or me. She also reassured me that I had done an amazing job to breastfeed under the circumstances - and eventually I believed her. Still, the first day I offered formula I was still a mess of tears and disappointment. I hadn’t cared about getting a big pregnant belly, I didn’t feel guilt about her early arrival, but not being able to continue breastfeeding felt so much like failure.

I continued to breastfeed as well as formula feed for several months, but Talia found the bottle so much easier and eventually my supply which had never been plentiful dwindled beyond redemption. However, I gradually relaxed and was able to enjoy it without worrying so much about her weight gain.

Now I look back and things are much more in perspective - the joy of 20:20 hindsight. It’s true that no-one can tell which babies were breast fed and which were formula fed. It’s true that giving my daughter breastmilk while she was in hospital was the most critical thing, and that anything beyond that was a bonus. It’s true that I fed for longer than some mothers did, and for a shorter time than others, that I produced more milk than some but less than others - but it’s not about comparing yourself to other mothers. I know I did my best under the circumstances I faced, which is as much I could realistically ask of myself, and that’s all that matters now. The guilt has gone the way of my breastfeeding cleavage, and it is not missed at all - unlike the cleavage.

Fine Motor and Play Activity Ideas for 12 month olds

I found another of those handouts from the OT department of the State Child Development Centre! Again this is not specifically for prems but just gives some ideas of things you can be doing with your child. Don’t panic if your baby’s development is delayed at this point, Talia wasn’t doing many of these things at 12 months corrected, but she caught up the following year. And if you need help at this point, KEMH will refer you on to physio etc after your 12 month corrected check up - or you can go private if you don’t want to wait that long.

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Babies learn through exploration about themselves and their surroundings. By 12 months old most children do things over and over again becuase that’s the way they understand how things work. Doing things repetitively also builds their confidence and strengthens the connections in their brain’s development.
Their individual personality will favour some types of play more than others. Follow your child’s lead in this, by giving choices within the playtime.
Their memory skills are also developing so they know that when you leave, you still exist and they know they don’t want you to go. This is why babies often get upset when you are out of sight.

At 12 months old (corrected age/full term) babies can usually do most of the following:

Play/Social Skills
- indicate wants and show toys
- show affection to familiar people
- show likes/dislikes and test parent’s reactions
- simple imaginiateive play - likes repetitive play
- explore
- start of no - resistive phase
- wave bye-bye
- know name and simple commands with gestures
- clap hands in imitation

Fine motor/perceptual skills
- pincer grip and poke with index finger
- stoop and recover objects
- show preference for one hand
- imitate scribbbling by end of 12 months
- variety of positions - sitting, crawling, standing - walking
- good visual memory noticing details
- aware of ends and means
- not mouthing objects as much
- post objects
- supinates forearm (ie can move hands to be palms up)
- voluntary release ie throws objects
- builds tower of two blocks
- removes pegs

Activities of Daily Living
- finger feeds
- holds spoon
- drinks from cup (held)
- co-operates with dressing
- sleeps 12-14 hours and naps

Activities that encourage Play & Development at 12 months
- push along toys
- toys that pull apart eg blocks/nesting/stacking toys
- large puzzles
- ball skills with large ball
- shakers
- hide and seek; peek-a-boo play
- screw toys
- pointing and looking at pictures in books together. Understanding the names of familiar objects in books
- action rhymes
- simple pretend play eg puppets, simple dress ups (eg hat on head), cuddling a doll, kissing a doll, feeding teddy or mummy, play “ta” games
- mirror games
- posting toys
- crayons for scribbling

Published by the Occupational Therapy Department, State Child Development Centre 2007