Learn more about what happens once you leave hospital & take a premature baby home, with My Expert Midwife
It’s common for babies to arrive a little earlier than expected, but those born before 37 weeks are considered premature – some by just a few days, whilst others may be weeks early. Most new parents are understandably a little anxious, but there are additional things to consider when it comes to babies born prematurely as they are smaller, have reduced fat stores and their body systems are still developing. This can affect everything from how to care for baby’s skin to the clothes, nappies or bottles you should use.
Planning to take your premature baby home after days or weeks of having extra care in a hospital can be both exciting and a little bit scary. We sat down with Jayne Airey, a registered midwife at My Expert Midwife, who offers her best advice to getting settled with a premature baby.
What happens on the Neonatal Unit (NNU)?
From the moment your premature baby arrives, the neonatal team’s primary purpose is to assess and care for baby. The nursing staff will support and encourage you to take care of baby’s basic needs, such as how to change their nappy, feeding and holding baby skin-to-skin.
Gradually, your confidence will grow. When baby is ready to go home, you’ll feel more prepared and aware of what to expect, so you’ll be able to recognise when something is not quite right and know who to turn to for help and advice.
Before going home with baby, the neonatal team will help you arrange continuing support from a community neonatal nurse or neonatal outreach team, your midwife, a health visitor and other care professionals. They’ll continue to offer you support, either by telephone, home visits or at a clinic, ensuring you have access to reliable information. They’ll also give you the reassurance of regular monitoring and weighing of baby, so you know they are developing.
How to care for a premature baby at home
Skincare
The skin is the largest and most important organ of the human body, as it provides a protective barrier for the body and its internal organs. In premature babies, the skin is extremely thin and very delicate, meaning they’re often more prone to infection.
It’s important to keep baby’s skincare routine very simple and use as few products as possible. Use plain water to wash baby’s delicate skin rather than creams or baby bath products, as these can contain perfumes and chemicals that could irritate their skin or remove the protective oils and bacteria that are naturally produced.
Ideally, keep bathing to not more than once a week, as this will maintain their skin health but won’t strip the natural oils or the good bacteria. You can gently ‘top and tail’ baby daily, using cotton wool soaked in clean warm water.
Nappies
Good nappy care for premature babies includes:
• Using a well-fitting nappy – this will help reduce chaffing and rubbing on baby’s skin, which can weaken its integrity
• Changing baby’s nappy regularly – urine contains ammonia and poo contains digestive enzymes, both of which can irritate baby’s skin if they have contact with it for too long
• Nappy-free time – allowing baby to get fresh air to their bottoms for at least 10 to 15 minutes once or twice a day, will help keep their skin ‘aired’ and healthy
Temperature regulation
Premature babies have less fat stores under their skin, which means they can quickly lose body heat and become cold.
To protect baby’s body temperature:
• Keep the room temperature between 16 and 21°c, you can using a room thermometer to monitor this
• Warm your hands before changing a nappy by rubbing them or putting them in warm water
• When undressing, bathing or changing baby, try to do it in a warm room
• Have everything you may need nearby before changing their nappy or clothes
• Cuddle baby (ideally skin-to-skin) during or after changing or bathing them, as this helps to regulate their temperature
• Put an extra warm layer on baby, like a knitted cardigan, and follow the individualised advice given to you by the neonatal nurse or team
• Keep hats off indoors
Safe sleeping
During their hospital stay, premature babies often sleep on their tummies but, by the time they are ready to go home, baby will be used to sleeping on their back.
The advice from Lullaby Trust* is always to:
• Place baby on their back on a firm, flat, well-fitting mattress, clear of any toys, pillows, or loose bedding
• Have their feet at the bottom of their crib
• Tuck their blanket under their armpits and underneath the mattress
Kangaroo care
Kangaroo care involves holding your baby against your chest, usually including skin-to-skin contact. and is a wonderful way to bond with baby. It is known to be beneficial for all babies, particularly for premature babies who have not had enough time in their mothers’ wombs. Baby, who is typically naked except for a nappy, is placed in an upright position against a parent’s bare chest – this could be either mum or dad.
Kangaroo care mimics life in the womb by keeping baby warm, contained, rocked and safe, and your breathing and heart rate helps regulate theirs, too. This all makes baby happier and more settled.
Babies born prematurely have missed out on some of their mum’s antibodies so they can be more vulnerable to infections. Together with colostrum and breast milk, skin-to-skin enables baby to lick and swallow mum’s skin flora, helping to build their gut microbiome and their resistance to infections.
Kangaroo care also:
• Eases their digestion and soothes reflux, colic and general tummy aches, thanks to the upright position and the gentle pressure and massage of their tummy against you
• Increased time spent doing skin-to-skin which has been connected to lower rates of postnatal depression for women
• Means you can see and respond to their cues of hunger and comfort, and notice early if they seem tired or unwell
Baby wearing
Babywearing is where you can carry baby in a carrier or sling that sits on your chest. It’s a way of keeping baby warm, safe and happy, all whilst staying hands-free throughout your day. Before you begin baby wearing, check with the neonatal nurse or midwife whether this is a safe method of carrying baby.
Some other important things to consider when wearing baby are to:
• Make sure baby meets the minimum weight requirement to go in the carrier safely
• Use a carrier or sling that is suitable for a premature baby
• Check that the material is wide enough to support baby’s bottom and whole body
• Ensure baby’s neck is adequately supported
• If possible, practise before taking baby home, so you get a feel for it and know how to use it
• Don’t put too many layers on baby – the carrier will provide warmth and protection, plus baby will be against the constant source of heat that is your body
• Position baby facing you, as forward-facing is not recommended until baby’s neck muscles are strong enough to keep their head upright for prolonged periods
• Follow the T.I.C.K.S. rule for safe baby-wearing: tight, in view, close enough to kiss, keep chin off chest, supported back
Car seats
When you’re ready to take a premature baby home, you’ll need to find a car seat that suits yours and baby’s needs and that fits your car.
To build your confidence, practise putting the empty seat in and out of the car and you will soon get the hang of it. Practise how the straps adjust and tighten (they need to be quite firm to keep baby secure whilst travelling) and also know how to loosen and undo the buckle.
When placing baby in the car seat, they should only be wearing indoor clothing so the straps are fitting against baby. Do not secure the straps over a snowsuit or a warm suit, a coat, bulky clothing or blankets, as doing so could put your baby in danger of overheating. Once secure, a blanket can be tucked in to keep baby warm.
Clothing
You will find standard newborn baby clothes won’t fit premature babies well, so buy a small selection of premature baby clothes and find items that are extra soft and which have flat seams, so baby’s thin and delicate skin is protected. There are specialist online suppliers of tiny premature baby clothes, but you can find items in supermarkets and baby stores.
Babies grow out of clothes quickly, so consider preloved as they may have only been worn a handful of times. Ask your midwife, NNU, health visitor or children’s centre about local resources.
Build your support network
Whilst your baby is receiving care in hospital, so are other babies. Their parents and other family members will have similar experiences to your own and could prove to be a valuable support at the time and even become lifelong friends. You will have shared memories and they will truly understand what it is like to have a baby born early.
By keeping in touch, you could support each other over the next few weeks, months and possibly years. There are also sources of support online which can help you to access groups in your local area.
Your mental health
Different people may see or remember events surrounding the birth from their own perspective and sometimes do not know how to express these thoughts. Acknowledge the powerful emotions you may be feeling and always ask for any support you need.
When a baby is born early, it usually means the parents weren’t quite prepared for baby’s arrival. You may feel hurt and resentful that you have to leave your baby in hospital and return home, whilst other new families all go home together. Travelling back and forth to the hospital every day can also be very tiring. Time spent with baby is precious, but you may feel observed and like you can’t act like you would at home. You will probably feel relieved that baby is receiving the best care, but equally sad you can’t care for your baby yourselves.
You may feel like you’ve been through a lot if you have a premature baby. If you’re feeling overwhelmed, it’s important to share your feelings with a partner or a loved one, or ask your outreach nurse or GP for help or access to signposting to further resources that could help support you.
*The-Lullaby-Trust-Safer-Sleep-Advice-For-Premature-Babies.pdf (lullabytrust.org.uk)
**Sling library, baby carrying consultancy & shop | slinglibrary.com
