Faking It

Expectations

We’ve covered the Good about having a baby (there is of course more than that, but there will be many posts to come outlining those items as they develop), but now I want to get into the Bad. These are the things that the baby books you read won’t tell you and the parents you talk to will not remember because they are caught up in baby bliss by the time they talk to you and they love discussing things with new members of the International Fraternity of Parents.

Your baby will not be how you expect it to be.

Your baby will still be wonderful and unique, but it will not be exactly what you have envisioned and nor will it conform to any real images of a baby that you have been fed in any books you’ve read or seminars you’ve attended. Your baby is here to bust up expectations and chew bubble gum… and he’s all out of teeth with which it would be possible to chew bubble gum so he guesses he’ll do that other thing instead.

Many books will simply give you a general over of “baby” as a sort of Platonic absolute. They will then list off things presented as sort of problems or variants from the norm and detail how a new parent should deal with them. Other books (notably The Baby Whisperer) will break down types of babies: Angel Baby, Textbook Baby, Touchy Baby, Grumpy Baby, etc. It is then presented that your baby will be one of these types of babies.

This is a wild mishandling of an expectant parent’s envisioning of their future. Your baby will be all of those things in its time, sometimes in the span of a few moments. By all accounts Joshua would qualify as a pretty Textbook Baby. He’s hitting his developmental milestones (few though there have been) and he doesn’t really have any health problems. But that’s where that match ends. There are times when he’s an Angel Baby, happy to sit and flail about and gaze at Mommy and Daddy. There are times when noises make him jump and flinch like any Touchy Baby and there are times when he will simply refuse to be calmed, a classic Grumpy.

Setting a parent up to believe that there baby will match a category can lead to some real parental frustration. “But I have an Angel Baby most of the time, what must I be doing wrong to make him cry now? I’m failing as a parent!” While it may be true that some babies have a tendency to display a certain temperament, that does not make them a Happy Baby. That makes them a Baby who is happy.

That’s my general lead-in. It’s important to remember that you don’t have a baby you read about in a book. You have your baby, and you could write a book about just them alone. Which is basically what I’m setting out to do.

Now, onto the specifics about Joshua’s birth and some of the general information that might benefit you one day.

Ultraviolet

Joshua came out a bit jaundiced. It wasn’t something that really noticed at all until after his treatment had started, but blood tests revealed that his billirubin levels (a yellow byproduct of red blood cell breakdown that is normally processed out by your liver – but can stick around and cause jaundice) were high. With babies, it is expected that their billirubin levels will rise as they start life, typically peaking at the third day. Since they measure danger levels of billirubin in the blood on a scale like this, if a baby has a level of, say, 9 on Day 1 that may place him in the high risk zone, but that same level on Day 3 means he’s safe and sound, since his levels did not elevate as they were expected to. This was the case with Joshua.

However, to help ensure his levels didn’t rise, he was given UV treatment. The treatment is simply that your baby is placed in a plastic container (pictured below). Lights are directed on him from above and the mat he lies on also emits UV rays. His eyes are guarded and he is intended to stay in that light for three hours at a time, and then to be taken out and fed to keep him hydrated. Then, it’s back into the light box. It’s important to keep a baby fed during UV treatment, as billirubin adheres to bile and urine and so the best way to have the baby flush his system of billirubin is to have him poop and pee it out. The better he feeds and excretes, the better his treatment will go.

The UV box

This makes for a pretty miserable treatment for a newborn. There are constant bright lights, which goggles are meant to prevent, but which surely creep in at the edges of vision, especially as your baby shifts about. There’s constant heat which dries the skin. There’s no chance to swaddle your baby to help prevent him flailing about and scaring himself awake. There’s no chance to really hold him outside of placing hands on him to soothe him. The box removes all creature comforts from a new baby outside of warmth.

If your baby is in UV treatment in the nursery and away from your room, you will be blissfully unaware of any discomforts, and so will the nurses, but more on that in a moment. However, if you can lobby to get the light box in your room (bonus of having the box in the room: they don’t put roommates in with you if you are in a shared room), you are pointedly aware of all these things and ministering to your child will become a constant task. It will be hard to watch him be forced to suffer and difficult to convince yourself that it’s a necessary treatment for a health problem that seems so esoteric.

Making matters worse for us was that our light box began to overheat. The ideal temperature in the box for a baby of Joshua’s size was 29.1 degrees Celsius. Under normal operation, this temperature would rise very, very slowly assuming all the little gates and ways to reach in and touch your baby are closed. Once opened, though, the temp should regulate itself back down. With our unit, however, it began to have issues regulating its internal temperature. I timed it. The box would take 5 minutes to heat up from its baseline temperature of 28.8 degrees to 30.6 degrees, the point at which it begins to issue forth an alarm that the temperature is too high. It would take three minutes for it to cool from the high temp back down to the minimum temp. Getting the unit to begin heating back up on its own before dropping below its minimum temperature setting was important, too. If it dropped below that set temperature, it would kick on its heater, exacerbating the timing for heating up and cooling down.

The net effect of this on Janelle and I is that in the middle of the night, for something like six straight hours, we were expected to, basically every four minutes, open up the door to the light box or close the door to the light box as we waited for it to begin to regulate itself properly again. When I informed the nurse that this meant that I would have to perform this function 80+ times over the course of the night, she nodded and said “I know.” And that was that. It was a rough night.

After 24 hours of UV treatment, babies are tested. If their levels are clean, they are taken out of the light and then tested again 6-12 hours later to see if they have remained stable. It is only after that final test shows positive results that you may be cleared to leave. Your baby will not be cleared of jaundice, but will have reached a point that his body will be able to take care of the rest on his own without much chance of danger.

The UV treatment was a rough patch for us, but it mostly illustrated a few problems with hospital care that I’ll get into now.

Ease of Care vs. Good of the Child

There’s a real disconnect in the hospital between what makes caring for a baby easy and what makes for the best care for your baby. A big problem with the care we received in the hospital was that providers used different philosophies in the care of the baby. Some will seek to educate parents on the best and most comprehensive methods, some will simply arrive and perform their functions and leave again. Some are focused on what is best in the long term for the baby, some are focused on making sure his immediate care is comfortable.

It is not necessarily that ensuring immediate comfort is wrong, it is just frequently counterproductive. In the case of Joshua, he wasn’t taking to the breast very well. Breastfeeding sessions (there will be a whole post on this) were really traumatic experiences to start. Without lingering on the topic too long now, breastfeeding is the mother’s first chance to bond in a true physiological way with her baby outside of the womb. It’s also her first chance to feel like an abject failure as a mother. I would not be shocked to hear that post-partum depression and breastfeeding troubles are closely linked.

Physically, Janelle’s body was well-formed to handle breastfeeding. Joshua, however, would simply react to her breast as if there was nothing there. He wouldn’t latch properly and when he did, he would stay on for about two minutes at most before twitching himself into a tantrum. Heart-wrenching and a big problem when he’s in the midst of UV treatment and requires nutrition on a tight schedule. We ended up being forced to supplement formula at the breast. This was done by taking a syringe filled with 10mL of formula and then connected that to a thin plastic tubing. That tubing would then be slid into Joshua’s mouth as he latched onto the breast. I would then slowly push formula through the tubing so that he was getting nourishment as he sucked, making him less likely to become frustrated and stop nursing.

Before we were able to get the UV light box in our room, the nurses would bring him back from the nursery every three hours to feed, and we’d deliver him 20-30mL of formula and breastmilk. Then they would take him back again. Well, as we learned ourselves after we got him in the room with us, he was super fussy in the light box. How did the nurses handle that? Weren’t they too busy to pay him constant mind? Did they just let him cry it out? Turns out they stuffed him full so he would pass out. A tried and true method of putting babies to sleep, but in this case directly counterproductive to our needs and his long-term good.

After the nurses took him back to the nursery, they would finger feed Joshua additional formula, giving him more formula so he was having 50mL in total at a time. This is an amount that Janelle’s body simply cannot compete with, so he was being trained to expect more food that his mother could possibly naturally provide. Also, since he was being finger fed (the same process of supplementing with formula described above, but the tube is inserted alongside your finger rather than a nipple), he got used to the feeling of a finger for feeding. Your fingertip is going to be much firmer and larger than a nipple, and therefore easy to grip onto. This is why when we worked with the hospital’s lactation consultant she remarked that it appeared that Joshua simply didn’t recognize Janelle’s totally normal in every way nipples. He had been trained to find something else palatable.

It makes sense the nurses would take this route when left to their own devices, as well. Babies are a lot of work and an easy way to put them to sleep is to tank them up and let them doze. Easy work, easy care. But what it caused for us were hours of a screaming baby and a heartbroken new mother. Better yet, the nurses actions were ones that the hospital’s own lactation consultant didn’t agree with. Warring factions.

The Hospital

Many people made reference that we should stay in the hospital as long as possible. It was even something covered on NBC’s The Office. Two characters set to have a child delay arriving at the hospital to the very last moment so that they can extend their post-partum stay there.

I straight up cannot understand this, but I can envision a set of circumstances where someone would want to stay.

If you were going for a C-Section, bottle feeding and don’t mind if the nurses take the baby away from you for every single test that they run so you can have some alone time, then the hospital works out great. But if you want the comfort to care for your baby in the way you see fit, you want the hell out of a hospital.

There’s a pretty good chance wherever you’re going will have you sharing a room. This is fine in and of itself, but space becomes a major issue. In a space that is probably 8’x8′ you have to fit a large bed, a movable tray for food, a bassinet, a privacy curtain and a chair that will fold out into a bed. This leaves, for Dad, about an 8′ stretch of space to move through. You will be uncomfortable and finding and organizing the things you need for a hospital stay of any real length gets very tedious.

Care in the hospital is competent, but as I have explained already, inconsistent. During the course of labor alone we rotated through three different OBs and four nurses. In post-partum, we had eight+ nurses, all with different ways of handling just about everything. In some instances it was great to get different pieces of advice, but each time there was a shift change it was a gamble to see if we would get someone that we liked.

To my mind, once we had time with a lactation consultant (which took three days, though every day we were promised she would be by soon) and once we had learned one really effective swaddle from a nurse, I was ready to get the hell out of there.

Coming Up: This three part breakdown will be a four-parter now. I’m going to devote special attention to a section I call The Drama, and then we’ll look at the items I consider to be the real danger zone items in The Ugly.