Visiting

You are allowed to visit your babies as much as you like. For most families, visits focus around the feeding times since the babies are typically sleeping the rest of the time. Getting sufficient rest is vital to maintaining your health and your milk supply if you are breast feeding, so once you are discharged, you can't possibly be there for every feeding. There are some overnight rooms where you can stay after you have been discharged if you are breast feeding. Ask the nurses for more information.

Develop a schedule. Parents typically spend 2 to 4 feedings a day with babies in the nursery.  It can be the same for all days or vary with your needs. Communicate your plans to the nursing staff. Ask them to post a note listing which feedings you will be there or call them to let them know when you are on your way. Arrive at least 15 minutes early in case one of the babies is hungry early.

The nurses maintain a guest register listing people you would like to allow to visit when neither parent is present. If someone is not listed in the guest register, they will only be allowed to visit when a parent is present. This is true even if the nurses have seen the visitor with you. When the nursery is busy, they limit visitors to 3 people at once.

If you have children in addition to your multiples, they are welcome to visit the babies with you.  Small non-related children and ill people are asked to not come in. There are windows that can be opened to show the babies should you have such limitations. If you as the parent are ill, please call the nursing staff and discuss this with them before going in so you don't put your babies or others in jeopardy.

You can get a hand code to be able to enter and leave as you wish. Ask the nurses about obtaining a hand code. If the one you ask is reluctant to provide it, or doesn't know how, ask another nurse.

Strategies for attending feedings (in no particular order):

• Both parents attend selected feedings together.
• You can each attend a certain number of feedings separately. You can attend one together and each take one alone.
• Drop one parent at the hospital for a feeding while the other runs errands and then meet up for the next feeding.
• Plan to be there for two feedings in a row and plan a short outing (lunch, shopping) in between.

It is not uncommon for one twin to come home before the other.  When one baby comes home, bring that baby to the feedings so that the twins have time together. Plan to attend two feedings in a row and allow the twins to sleep together between feedings. Place something that each twin wore in the crib with the other twin so that they can still have each other's scent. When you have one twin at home and one in the nursery, it is even harder to manage your time than if you have both in the same place.

Staff

Get to know the nurses well. While you are in the hospital, you can get to knowa few nurses from each shift. The more you are there, the better you will know the nurses, and the better you will know what care your babies are getting and how they are progressing. The nurses are almost always very special people to be in their positions.

Call whenever you want to discuss your babies. Even in the middle of the night, if you want to call for your peace of mind, do that. There is always someone to answer the phone. Occasionally they may need to call you back if the nurse assigned to your babies is in the middle of a procedure or meeting with a doctor.

Ask, ask, ask questions! Lots of them.  Ask the doctors, the nurses and the other parents. Ask for daily updates from the doctor on call. Ask again if you feel as though your question hasn't been answered in a way you understand. Verify that the nursery has your correct phone number. You are the parent and have full rights to know any details on your babies. Take notes and be bold!

Medical/Equipment

Keep track of all medications, and treatments that each child is getting. (it helps you feel involved and it helps ensure that no one forgets which child should be getting which treatment) Write notes on a pad or a hand-held device .

If your twins have a particular medical problem, ask if someone in the club has been through that experience. Generally there will be someone who has a similar issue who would be glad to talk to you about it.

All babies born at PVH have a hearing screen and some blood tests. Additional tests that may be run are head and body sonograms/ultrasounds, more blood tests, and a vision test. Ask the nurses to inform you when tests are going to be done and be sure and clearly tell them if you want to be there.

There is a lot of equipment in the Special Care Nursery. Your baby will be connected to monitors to track hear rate, breathing rate and possibly additional vital signs. They seem to beep often. It is very common to have the connectors on the babies come loose. Ask the nurses to show you what is normal for your babies. If your baby looks fine and the machine beeps, look at the display to see why. Is it showing that your baby isn't

breathing? Then look at the baby and see if she is breathing before you start to worry. Usually all is well, and if something is wrong, there are nurses allover that you can quickly have come over to help.

your baby may also have other equipement. All of the equipment can feel intimidating, but the more you learn, the more comfortable you will be. Some of the common equipment includes:

• Heart/Respiratory monitor -a machine which tracks the baby's heart beat and breathing
• Pulse Oximeter -a cord/sensor attached to the baby's hand or food, used to measure oxygen in the bloodstream
• Warmer -a special bed that helps keep the baby warm. A small wire attached to the warmer and baby's skin controls the amount of heat supplied
• Isolette -a bed enclosed in clear plastic to keep the baby warm
• Nasal Cannula -a clear plastic tube with ends that fit in the baby's nose, used to supply oxygen
• Oxygen hood -a clear plastic box that covers the baby's head, used to supply oxygen
• Ventilator -a machine that helps the baby to breathe
• Umbilical catheter -a tiny tube inserted into an artery or vein in the baby's belly button

It is common for very premature babies to have problems regulating their breathing and heart rates. Two concerns are Bradycardia, a slow heart beat, and Apnea, a pause in breathing. Because their nervous system is immature and would not have to deal with breathing in the womb, the baby can stop breathing for a few seconds. It is common to have the heart rate fall under 80 beats a minute with this pause in breathing. Most babies with gentle touch begin to breathe and have the heart rate come right back up. The monitors help identify this when it occurs.

Some babies will have medications as well. Very premature babies have lots of tubes and wires running all over the place. These replace the care your body would have given in the womb. There may be even some small tubes that run in through the bellybutton in addition to regular IV's. The baby's veins and arteries are so small that the bellybutton can be a critical and wonderful help to the care your baby needs.

Babies born earlier than 34 weeks often have problems breathing. It is common to have a chest X-ray to assess the lungs. Additionally, the baby may need assistance for breathing. The most serious is a ventilator, followed by an oxyhood and a nasal cannula.

The ventilator is a machine to helps the baby breath. Babies on ventilators are monitored very closely. Nurses will make sure the tubing stays clear of saliva. The oxygen and carbon dioxide levels in the blood will also be tracked. The baby cannot be held during this level of care, but you can gently touch and comfort the baby. The nurses will show you what is appropriate.

The oxyhood is a clear bowl-like object that goes over the head completely and is filled with air at the right oxygen level for your baby. The oxygen concentration is gradually reduced. The babies still cannot be held with the level of care.

The nasal cannula is a tube that releases oxygen in the baby's nostril which then mixed with air. The nasal cannula is used when the baby needs about 30% oxygen or less. Typically you will be able to hold your baby at this point. Once on the cannula, they are slowly weaned off oxygen to room air. It is not uncommon for babies to go home on oxygen.

It is also common for babies, both premature and full term, to develop jaundice. Jaundice is characterized by a yellowing of the skin. If the jaundice becomes severe enough, the babies receive phototherapy. They use a mask to cover their delicate eyes and uncover the babies down to the diaper. The purplish blue lights help lower the blood levels of bilirubin. If you are in a lot during this time, sun glasses for yourself might help, as some parents get a headache from the lights. The babies are usually under the lights just for a couple of days. You are still able to touch and hold your baby during this time, it is just limited a bit so they are under the lights as much as possible.

Eating

When the babies first start in the Special Care Nursery, they may be placed on IV's. Some babies can start on bottles right away. For very early premies, a naso-gastric tube is placed through their nose and throat and into their stomach. Milk is gravity fed through the tube. For very early premies, a bottle is started just once a day. Theh the frequency is slowly increased until all feedings are from the bottle. Because of being born prematurely, the suck-swallow reflex can be slow to develop.

About 85% of premature babies have acid reflux, a condition where the small muscle at the top of the stomach fails to tighten and acid comes back up the esophagus. This is very uncomfortable for the baby. There are medications to help. It is very important to get reflux under control, because eating aversions (where they don't want to eat) can develop and slow the progress of the eating.

If you want to breastfeed, tell the nurses right away and also start pumping 8 times a day within 2 days of birth (preferably within 24 hours). If you had a c-section without going into labor or have been on magnesium sulfate, your supply may be a day slower to come in, just be patient. When pumping, use lanolin to lubricate your nipples, the nurses should provide you a small tube. Get permission as early as possible to have the baby at the breast --even if she can't nurse yet, she can get the feel of the breast and your smell, and you can get comfortable holding her. This can often be done during the Kangaroo Care. For more on breastfeeding multiples, refer to Mothering Multiples or talk to one of the club members who has successfully breastfed.

Ask for and keep some of the disposable bottles that the nursery uses. You can use those at home until the babies are taking a larger volume.

If you are breastfeeding, plan to pump using one of the breast pumps at the nursery .Be sure to bring along your necessary pump parts. If you happen to forget bottles, ask the nurses for some of the disposable bottles the nursery uses -they work with the Medela breast pump parts.

Your twins in the nursery will probably have to be bottle fed at least some of the time. Most babies go back and forth between breast and bottle easily. If yours seem to prefer the bottle and you want to breastfeed when you get home, talk with the nurses. Several are lactation educators and have experience working with other breastfeeding moms. Don't get easily discouraged, you can focus on breastfeeding when you get the babies home.

Remember that premature babies get overstimulated very easily, so a quiet visit is important for not just your babies, but for others in the room. The nurses will help you learn developmental care for your visits, so you are meeting your babies needs and so you can enjoy close touch that benefits both you and the baby. Occupational and Physical Therapists evaluate all babies born before 35 weeks. They will help you to learn cues given by the baby to know when they are being overstimulated. Their nervous systems are underdeveloped and can get readily overloaded. With the special handling they will show you, the baby will love your appropriate touches, and you'll feel great knowing how to understand and help meet your babies needs. The nurses will also show you Kangaroo care, skin to skin holding of the baby on your chest. Both the father and mother can do this. Most babies (and parents) love this and readily stabilize and achieve a sound deep sleep during this close time, as they can hear your heartbeat and breathing, and this helps them. Maintaining body temperature is another critical care point for premature babies. Most babies start in an open warmer. This has a heating unit above controlled bya temperature probe placed on the skin. The next step is a temperature regulated isolettes. Finally, babies are moved to open cribs. Body temperature is critical because babies need to use their calories that they take in to grow, but if they are too cold, they will use calories for warmth instead, so weight gain will stop and even turn to weight loss.