No Oxygen

It is always exciting in the NICU to get rid of another cord or tube. It signifies the baby is starting to be free to live on his own.

We were thinking Joshua would be off his oxygen for a couple of weeks there and he was making us anxious to be done with it. His alarms would beep the good way if it was on, but if they took him off the oxygen completely he could only go a few hours until he would need the oxygen again. They ended up turning the oxygen part down to just room air and leaving the tiniest amount of flow going, and that worked, until one day he was finally able to be like this:

Look how smug he looks just having his feeding tube in, and the giant binky.

Coming off the oxygen did cause some feeding issues, but the freedom was wonderful.

Jammies

While Joshua was in the NICU we just bought him onsies because they were easiest to get around all the tubes and wires and because he never went anywhere anyway. But I have a thing for babies in sleepers so one night Joshua got chilly after a bath and so they put him in one of the sleepers the NICU had. I had to take a picture because he was so cute.

Brian the early dad

I found these pictures of Joshua and Brian and I thought they were amazing. Not the photography itself, that isn't great, but the love you can see between the two of them. So I thought I would dedicate a post to what Brian did while Joshua was in the NICU. And put in the pictures how they fit or just randomly if they don't.
When Joshua was born I quit working, my poor boss got two days notice, and that was only because Joshua was born on a Friday, and I wasn't supposed to be at work again until Monday. Fortunately Brian had a decent college job that would pay our bills to tide us over the summer until he started his real job. The plan was for us to save up some money during my last trimester when both of us would be working decent amounts so we could have some money for the baby and Brian could take some time off. Well Joshua through a loop in those plans. We had some savings, but we also knew that there would be a three week gap between Brian's jobs and we had to get ourselves across the country so we didn't want to dip too much into that. So Brian hardly took anytime off while Joshua was in the NICU.

Fortunately Brian had a job where he could do most of his work from our laptop, so he would come to the hospital with me and work there almost everyday. Brian spent an incredible amount of time at the hospital each day probably over 10 hours on weekdays between working and actually visiting Joshua. I remember he said once that being at a hospital that much was kind of depressing, but he still did it. Even though I spent more actual time with Joshua, I would be in and out, and in the pumping room, but the staff knew where to find Brian. Everyday the doctor would call or talk to the parents of the babies, and he would usually just go down the the parent's room to talk to Brian.

Brian would also help me with the pumpings. When we were at home he would drag the heavy hospital pump to where ever I wanted to be for the pumping. He would also get up in the middle of the night every night to help me get the pump stuff all assembled and the milk put up in the end, so that the whole process would go faster and I could get back to sleep faster.

Joshua would always have this content look on his face when Brian held him. I would envy Brian sometimes towards the end when my visits with Joshua revolved around trying to get him to nurse. It seemed like Brian was able to just enjoy him more sometimes.

I love this picture too, it looks like they are hugging.

Letting Others hold Joshua

For the first month or so Joshua was in the NICU we were only allowed to hold him twice a day. So I would hold Joshua in the morning and Brian would hold him in the evening. We wouldn't let anyone else hold him because we felt like we as his parents should get to hold him every day. We never asked for extra holdings for him because he had such a rough time before.

Then sometime around Memorial Day they said that we could hold him a third time. I held him the extra times for the first few days and he did great. Brian and I decided that someone else could hold Joshua. My parents were out of town on an anniversary trip, so we called my sister Heather and asked her if she would want to come hold him. Heather was the first person besides Brian and I, and the NICU staff to be able to hold Joshua. Unfortunately we didn't get a picture of it.

I am pretty sure at some point Emily came and held him at some point, but I don't have a picture of it, and I don't remember. Sorry Emily. Nathan wasn't allowed in the NICU at all because he was too young. You had to be sixteen to go in and Nathan was only 12. The closest he got to Joshua, is once Joshua's area was by a window to the hall, so Nathan came and the nurse picked Joshua up and held him up to the window so Nathan could see. Poor Nathan.

When my parents came back they were able to come hold Joshua too. The first picture I have is with my dad holding Joshua.

The next picture is with my mom holding Joshua. The one with my mom is taken later, it must not be the first time she held Joshua, because I am pretty sure she held him before my dad.

On a side note, my parents were very supportive when Joshua was in the NICU. They visited him all the time and even went to the "You have a baby in the NICU class" a couple of weeks before Brian and I made it there. Then after over a month of waiting they were finally able to hold their first grandbaby.

Zacky

Brian is working swings today so it is time for my updating Joshua's NICU story. This is short and sweet.

In the NICU they have these pillow things that look like hands, and they are made to have the weight and feel of a hand too. The pillow is called a Zacky. The Zacky is supposed to make the baby sleep better or whatnot. I don't really know if it helped Joshua sleep or not, but we liked to put it on him. He didn't get to bring it home though, so here is our picture of him sleeping with the Zacky.

Feeding Joshua

The feeding of Joshua evolved through his NICU stay but I will put it all in one post.

He started out purely on IV nutrition for about a day, then when I was released from American Fork Hospital and was able to go visit him at UVRMC they had me sign a release form for him to have pasteurized human milk until my milk came in. Within a couple of days he was eating just my milk, but it was all going in through a feeding tube. Sometimes a nurse would give him a taste of milk so he could get used to the taste and like it. We learned not to ask the nurses because other nurses would look at us like we were crazy when we asked. The weird part about the beginning of his feedings is that they needed to know if he was digesting the food or not. So before every feeding they would suck stuff back out of his stomach and if it didn't look too bad they would put it back in, but if it looked nasty they would throw it away. That was not my favorite part.

In preparation for breastfeeding they had me do skin to skin holding with Joshua. Brian also held him skin to skin for bonding purposes. A couple of weeks before he would be old enough (based on gestational age) to try nursing Brian was holding him and Joshua started rooting around looking for something to suck on. The nurses and we decided that we could start him on the nursing path a little early.

The NICU has several lactation consultants to help the mothers learn how to nurse. Nursing a preemie is more difficult because of their size and age. They helped us get correct positioning which is even more crucial with the preemie, and they gave me a nipple shield to let Joshua get a better grip to suck since his mouth was so small. He was so small when we started, my boob was significantly larger than his head. I had imagined nursing to be fairly easy and I would just hold him in the crook of my arm, but it was fairly complicated.

The first part of working on nursing is non-nutritive nursing. This is where I would pump right before I went to visit Joshua so I would be empty, then they would hook up his feeding tube and feed him while he practiced nursing. Well that is what is supposed to happen. That night we had a little bit of a frazzled nurse so by the time I actually got to sit down with Joshua it was quite a while past his original feeding time. Then she forgot to hook him up. Brian and I were confused about exactly what was supposed to happen so we just let him suck for a while. Then she came back and we realized that she thought that he was going to do a nutritive feeding instead. I didn't think he had nursed that much, but when she hooked him up he spit up most of his feeding. That was the only time he spit up in the hospital (he came home and spit up a ton, I don't know what the difference was), so I think he was hungry and actually nursed.

After that he got a little cold and after he recovered we decided to try nutritive feeding. To figure out how much the baby was eating we would weigh him before the feeding and after the feeding, and the weight difference would be how much he ate. A milliliter of milk weighed 1 gram, so the conversion was super easy. The first time I nursed him for real, a full feeding for him was 32 ml, the nurse said to be happy if he got anything, and not to expect anything too far over 10 ml. Well Joshua nursed 30 ml that first time. Totally rocked it.

When the babies started nursing they are only allowed to try twice a day. When they nurse at least 3/4 of a feeding twice a day, then they can try three times a day. Then comes four a day, but with a break in between feedings, then 4 in a row/12 hour, then for 24 hours, then on demand.

It only took Joshua a week to go from 2 a day to 3 a day nursings, then we got stuck. One of the reasons is I didn't cut back my pumpings at all and with 3 added nursings my milk supply went from a lot to out of control. So I started choking the poor baby. He had this thing that if he would choke he wouldn't try to nurse for like a week. It took us like 3 weeks to get over 3 a day. He also ended up being fairly anemic during this time (it is normal for preemies to be anemic), and was borderline needing a blood transfusion, but with the lack of blood he was sleepier and less interested in eating. During the 3 a day, he was also able to start drinking out of a bottle. Brian got to give him the bottle, and even though it was really hard for Joshua at first, he soon was rocking the bottle too.

When he got to four a day he was finally nursing consistently. During this time he was able to come off oxygen except for during feedings. A couple of the nurses got it in their heads that he didn't need oxygen during feedings even though he needed the oxygen turned up every time he was fed. So they wouldn't let him have oxygen while he at, and he choked and went on strike again. I was quite annoyed.

The NICU has a baby feeding guru named Annie. She didn't spend tons of time with us, because even though Joshua was slow moving along, he had some really good nursings, and was obviously capable of doing well, and there were alot of babies with more difficulties. When we got to four a day, she left for vacation for a week, and planned on us being home when she came back. She was surprised to come back from vacation and find us in the same place as we were. She promptly gave Joshua back his oxygen for his feedings and within a week and a half he went off strike and we ended up home.

He went home with blowby oxygen for his feedings, where instead of hooking up a cannula with oxygen for his feedings we just blew oxygen in the general area of his nose and mouth. I would just weave it through my bra when I was nursing, but Brian came up with an ingenious way to blow the oxygen on his face when he fed Joshua the bottle. He just taped the tubing right to the bottle.

That is how feedings went with a preemie. I had no idea how complicated it was, until I had my second and she just nursed without any contraptions. Good thing Joshua was my first.

Joshua's first bath

Okay it actually wasn't his first bath, but it was the first time Brian and I gave him a bath. I actually went in that day to try to nurse him, but he had gotten a cold. Joshua was all stuffy and miserable, so I didn't think it was a good idea to nurse him. Our nurse suggested that we give him a bath instead.

We had not been at the hospital for his bath before. They would always do the baths during the night shift, but the nurses were usually busy during the first feeding of the shift, so we would be gone by the time they would give him a bath.

Joshua loved soaking in the warm water he would be super relaxed.

But he didn't really like getting his hair washed.

It was a lot of fun and it seemed to help him feel a little better.