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.

The healing process

Ever since Talia was born, I’ve been ambivalent at best to fullterm newborns. They seemed so different, almost alien. I felt quite negative about seeing them; even though my head told me everything was OK, clearly in my subconscious I still harboured either some sadness or anger or jealousy or maybe just a yearning for other people to understand what I had to endure. I wasn’t proud of these feelings, but they welled up within me of their own accord.

Then this week, a friend with a premmie son the same age as Talia had a daughter, Elizabeth, born at 38 weeks and for the first time in two years I looked at a photograph of a full term newborn baby and felt only happiness and relief.  Yesterday an old school friend had her first child, a full term baby, and again I felt only joy and excitement.

It has been a slow process but I think I really am now healing emotionally.

The last day of zero

I’ve been feeling anxious and emotional all day, and as the hours went by and it came closer to the anniversary of Talia’s birth the feeling just became stronger until here I am now, mid-evening, sitting on the sofa with a box of tissues and wiping away the tears.

This time last year I was in a shared ward with other expectant mothers. I’d had an ultrasound in the late afternoon which showed my baby’s feet clearly pressing down on my bulging, partly dilated cervix. As a result I’d been told to go immediately back to bed, keep my feet up, and not get up unless I needed to use the bathroom. My hopes of going home in a day or two were dashed, and I anticipated a long, boring period of bedrest waiting for “Tic-Tac” to grow and hopefully arrive close to her due date.

My lower abdomen was sore, and I mentioned it to every nurse who came to check on me, but each time they felt me they said it was still soft and it was nothing to worry about. I remember I was in tears that evening too, because I’d asked if they would call my mother if anything happened (like me going into labour) and they said they couldn’t guarantee it. I felt lonely and miserable. Around 11pm I felt I was unlikely to sleep with the pain in my abdomen and rang to ask for some panadol. The nurse who arrived to see what I wanted felt my stomach and immediately called for someone to take me down to a labour ward. As they wheeled me out I was begging them to call my mother.

Down in the labour ward I was in a big room by myself. I met a funky young midwife named Xena and was introduced to a handsome young surgeon whose name I forget, but in chatting we discovered we had both gone on student exchange. My labour pains were intensifying and they offered me morphine. Not knowing how long I would be in labour, and being a total wimp, I accepted it. In retrospect it was the only thing I regret, because I was a zombie for the following 24 hours.

Not knowing if the nurses had called or not, I asked Xena if she would contact my mother. However no sooner had she started to leave the room than in came mum. A nurse had called and left a message when she was asleep and didn’t answer the phone quickly enough. However the number they said to call back on was a wrong number, so mum just assumed the worst and got straight into the car and drove immediately to the hospital and buzzed security to be let in. It was around midnight. I remember holding mum’s hand really, really tightly as we waited to see what would happen.

It must have been close to 2am when the surgeon decided that it was too risky to let me continue labouring. With Talia in the footling breech position, if my waters broke her body might easily slip out leaving her head stuck, and there was a real risk of umbilical cord prolapse - which could lead to brain damage or stillbirth. I don’t recall the exact sequence of events following that, but I was moved to an operating theatre. I can recall going through a series of swinging doors, like you see at the start of medical dramas on TV. I met a couple of friendly anaesthetists. One was almost a stand-up comedian, he just had one joke after another as he supervised his more junior colleague painting my back with a cold liquid before he put in the epidural. By this stage the morphine had taken effect and I was not in so much pain, but everything felt not-quite-real, as if I was watching it all happening to somebody else. Sleep deprivation may have also been to blame.

I met up with my mother again in the operating theatre. The room seemed to be full of people - two surgeons, the midwife, the anaesthetists, three people from the NICU. I remember that I could feel nothing from the chest down, but from the chest up everything was shaking uncontrollably, as if I was cold although I don’t recall being cold. I didn’t even feel quite so frightened by that stage, just numb and vaguely annoyed that I couldn’t stop my arms from wobbling like jellies. I would have liked to actually see what they were doing but perhaps it was better not to. Mum could see some of the action reflected in the big silver light over the operating table as she held my hand again. She told me about the big blood clot which was behind the placenta, and possibly the cause of my premature labour.

I had no idea how long it would take but was still surprised at how quickly everything happened. They started at 3am. Within minutes Talia was out and being bubble-wrapped by the NICU team. It took a little longer to stitch me back up again, but even so it wasn’t long. A NICU person held a pathetic wrinkly red-faced bundle near me and I reached up to brush a finger on her forehead before they whisked her away. Mum stayed with me in recovery, but I only recall recovering long enough to finally fall asleep.

When I woke up it was morning, and the morphine was like a haze. I was in a private room, and someone had brought me a polaroid picture of my baby. I remember looking at the photo and feeling empty and slightly frightened because I didn’t feel any emotional connection, no rush of love, only blankness as if I was looking at a stranger’s baby. At the same time I felt physically empty too, because Talia had always been a wriggly baby who kicked regularly and I felt barren without the movement inside me.

The rest of the day was a blur. I recall very little, other than speaking to my stunned husband on the phone from Singapore, and my mother arriving with a bunch of striking blue orchids. In the evening I agreed for Talia to take part in a clinical trial, and someone showed me how to use a breastpump.

So much has taken place since then.

Today I made a cake, blew up balloons, got ready for the big day tomorrow. My husband is in Singapore again and it all seems a bit unreal. To celebrate the last few hours of her last day of being zero, I packed a bottle (of milk for Talia) and bought some takeaway and we sat in the park in the twilight and watched the ducks and the dog-walkers together. It was incredibly peaceful and such a beautiful contrast to the same night last year.

This day last year

It’s mid-evening, March 17.

This time last year I was lying on a hospital bed in a delivery room, two monitors strapped across my belly and a machine next to me like a seismograph printing out the magnitude of my labour tremors.  I think my legs were probably trembling just as badly, they certainly felt like jelly earlier in the evening when the head of the obstetrics department told me I could be having a baby within hours.  I was really, really frightened, and hoping against hope that the medication they had given me would stop my labour so I could go home until my baby was actually big enough to be born properly.

Tonight I baked sesame shortbreads for Talia’s birthday on Thursday, and read a lot of chatter posted by other premmie mothers who I now think of as friends, even though I’ve met almost none of them in person.  Things didn’t go to plan last year, but thankfully, like the best sort of stories, it seems to have all turned out OK.