To say I was excited when my wife was pregnant with our first child, Morgan, would be a gross understatement. While this overwhelming sense of joy continued to grow along with her belly, I could never have prepared myself for the days and months ahead as a new dad. I imagined fatherhood as one thing, and turns out, my thoughts and emotions were pretty spot on -- times 100.

Expectations: What I Thought I Felt

During my wife’s pregnancy, I wasn’t nervous; just extremely excited. I looked forward to knowing there was someone who would come to understand they could turn to me for anything in life. The only nerves I had as a dad-to-be, were tied to ensuring my baby was a healthy one, and knowing how to respond in different situations. Now I like to think of myself as a smart guy and efficient problem solver, making unplanned decisions every minute of my workday. I constantly get thrown curveballs, and am able to use knowledge and reasoning to figure out the best solution. Why should a baby be much different?

I felt like I did everything new dads are told to do to prepare: read The Expectant Father, talked to other parents. They helped me understand my wife’s experience, -- physically and emotionally -- my own experience, and what was in store once the baby made her first appearance. I looked forward to all the firsts, and to share my favorite things with our child.

What didn’t make me jump for joy was the actual birth part, as I knew I had to be strong for my wife, but having a sensitive stomach, I felt queasy at the thought of watching this oozy miracle happen before my eyes.

 

Reality: What I Feel Now

When my wife was pushing out our child, all queasiness left the room. I couldn’t believe my eyes: I was witnessing our creation come into this world. The minute my wife held our child, I was pleasantly surprised at what a natural she is. All of her nerves went out the room and her maternal instincts kicked into high gear. From day one, my wife showed confidence, love, knowledge, and connection as a mother.

I, on the other hand, began questioning everything. I had difficulty advising my wife on decisions, solutions and actions. I simply didn’t know the answers (maybe Google would?) I was surprised by how much more cautious and nervous I felt, when in my head I thought I would always be a cool and collected new dad. Did she eat enough? She’s hungry again? Why is she crying? Why isn’t she crying!

Despite the worry, the overwhelming joy I thought I felt during my wife’s pregnancy was put to shame each time I looked at my baby. I felt extreme pride at Morgan’s firsts -- lifting her head during tummy time, smiling, playing with toys on her own. I couldn’t believe I felt excited and relieved at each poop, each burp, knowing everything was functioning properly. I felt happy when Morgan slept, knowing she was getting the rest she needed, and happy when she woke, knowing she wanted to eat (and was still breathing!)

Watching a baby experience and learn something new every day is fascinating. Hearing ‘dada’ for the first time and watching Morgan take her first steps as she walked into my arms created incomparable pride. I knew being a dad would be great. Yet there is no way your expectations of greatness are in line with how truly remarkable the experience is watching a helpless thing grow into an independent mover and shaker.

Photo by Kelly Sikkema on Unsplash

Being pregnant with a toddler running around can be challenging, to say the least. You may not always have the energy to keep up with your little one, and getting ready for a new baby can rob you of precious together time. But it is possible to bond with your older child, tackle your new baby to-do list, and even reserve a few hours for yourself during these months. Check out these tips for making pregnancy with a toddler in tow as smooth as possible.

Take advantage of naps. Your new best friend: the afternoon nap. Life with a toddler while pregnant leaves little downtime, so use his naptime to catch some shut-eye yourself. Pre-nap, wind down together with a calming activity such as reading a book or listening to music, which will help prepare him for sleep. He will love the extra cuddling with you and you’ll appreciate the peace and quiet. Afterwards, head to bed for much needed rest.

Bring in a babysitter. Consider hiring a mother’s helper for a couple of afternoons a week. Your child will enjoy the additional attention during this phase when so much focus is on the new baby, and you can use the afternoon to catch up on your rest or do a few things outside of the house. Schools and places of worship are great places to get referrals for local mother’s helpers. If you’re not comfortable leaving your child alone at first, you can always stay at home in a separate room.

Involve your toddler in baby preparations. Toddlers will delight in helping you get ready for your new addition, and you’ll simultaneously be able to check tasks off your new baby to-do list while hanging out with your older child. It’s a great opportunity to bond and talk about what to expect after your new baby arrives. Your tot can help fold baby clothes, place clean diapers in baskets, or arrange baby books on a shelf.

Prioritize your time. Accept that you may not be able to do everything you'd like to when you’re pregnant, with a toddler in tow. Let a few things slide in order to fit in special bonding time. Mopping the floors or updating your blog can wait. Spending those extra hours with your child before the new baby comes will help your toddler feel secure during the transition.

Remember to give yourself a break if things don’t go exactly as planned. This is a big change for your household! Before you know it, you'll be watching your firstborn become a proud big brother or sister to your new baby.

Photo by Colin Maynard on Unsplash

Having a baby in the NICU is a challenging time where hopes and fears can change daily. When your baby is born prematurely, the neonatologist will be looking to make sure that heart function, lung function, weight gain and ability to maintain body temperature are all stable before discharging your preemie. The length of time that can take will vary widely, according to how early your baby was born.

You’re still dealing with all the things that parents of babies born at term have to handle, such as choosing a pediatrician and installing a car seat. On top of that, your preemie has special needs. You surely wish you could take him home right away, but your premature baby requires more medical attention that you may have anticipated. Take heart -- there are things that can help parents of preemies along the journey to taking your baby home.

Recovery: A silver lining is we can use the time our baby is in the NICU to recover from the birth: to rest and be well nourished. Travel back and forth can be tough, but it’s critical to realize you will not serve your premature baby well by neglecting yourself. Just as the NICU is extending baby’s gestation phase, a new parent needs to take care of themselves to be ready for when your preemie comes home.

Educate: Take an infant CPR class before your preemie is discharged. If your baby is being discharged with a heart or apnea monitor, you will have to attend training on how to use these monitors before you take your baby home. If you plan to breastfeed, find an Internationally Board Certified Lactation Consultant who can work with you to maintain breastfeeding and weight gain once you're home.

If there are older siblings, explain that things will need to be calm for the baby at first, and establish strict hand washing protocols to prevent illness. Your hospital may also have a transitional stay room, where parents can practice taking care of baby for a day or two before coming home.

Support: Line up your support system, both physically and emotionally. First time mothers -- especially of preemies -- can feel very isolated. There are many online forums and support groups to connect with other moms going through this same experience. With babies, and especially with multiples, an extra pair of hands helps. As our job will be to care for the baby, help with shopping, cooking, and laundry becomes very valuable. Enlist friends and family so that you have more room to focus on the baby.

Time and Transport: Preemies can usually only travel an hour at a time. In urban environments or hospitals far away, anticipate a rest stop on the way home. Once your baby is home, you will not have time to waste on finding papers or scheduling time off. Establish a baby medical file -- log doctor and insurance company phone calls. Extend, space (e.g. use one week to take every Wednesday for five weeks) or delay maternity or paternity leave to map out which parent is with the baby and when, and pull in relatives or childcare where necessary.

Coming home from the NICU can be filled with relief but also trepidation. While it is natural to be nervous about being up to the task of taking care of such a fragile baby, obstetrician Dr. George Mussali puts it beautifully: “The fact is that a preemie parent matures faster as a parent due to the adversity they faced at the beginning.”

The first year with your preemie often involves juggling many check-ups and appointments. Because our babies’ brains and bodies are so plastic, early intervention is a critical tool for supporting preemies. Premature babies are always evaluated based on their ‘adjusted’ age rather than their actual age. This means that if your baby was born at 32 weeks, when they are two months old (8 weeks) they are evaluated as a newborn.

Dr. Yasmin Lyons is a pediatrician who has worked extensively with preemies. She emphasizes that: “Often the baby is doing what is completely normal for their corrected age, and it’s important for parents not to compare the progress with that made by other babies.” You’ll quickly decide who to talk to about your baby being a preemie. Margie, a mother of a preemie born at twenty weeks, told me: “I just always gave the adjusted age of my preemie because I just didn’t want to have to have the whole conversation with strangers."

As parents of preemies, we start feeling more confident when we see our baby eating and reaching textbook milestones. This can vary dramatically depending on how premature our baby is. In other words, a “30-weeker” will have a very different roadmap in the first year then a “34-weeker.” Hospital preemie clinics can be a good resource for reassurance. Premature baby clinics in addition to a pediatric neurologist often include an occupational therapist and a physical therapist, allowing a more thorough evaluation of the premature infant. Susan, a mother of a 33 week preemie, told me: “I was worried because Isabel wasn’t holding her bottle. The neurologist at the preemie clinic told me, ‘Oh she can totally do it, she is just choosing not to!’ I was so relieved that she was on track and making her own decisions!”

The most important thing to understand is that your preemie will always be evaluated at their ‘adjusted’ age, allowing an equal playing field in the evaluation. Based on adjusted age, your doctor will be looking for the following things:

At three months: Gross motor skills: open hands, some holding/grasping, some neck control, visual tracking (i.e., following an object or person with their eyes), cooing vowel sounds, smiling.

 

At six months: Gross motor: rolling over, head control, pushing with their legs while you are holding them, spinning on their stomach, holding toys and shaking, bringing toys to their mouth, lots of prolonged eye contact, engaged with those around them.

9-12 months: Gross motor skills: “the army crawl” (pulling themselves forward on their tummy), sitting up on their own, holding and shaking toys, pulling upright. Language progresses to consonants and vowel sounds strung together, with a few words identified. Smiling and laughter is a regular part of your life.

As a general rule, pediatricians give premature babies a wide margin to be reaching targets based on how premature they were. Variations within a twelve week range can be normal, yet with good intervention concerning physical, occupational, and speech therapy, almost all premature babies are deemed “done” with being “premature” by 24 months!

With a preemie, it is important to understand that the first 100 days at home need to be treated like a “fourth trimester.” This means low stimulus, few visitors, and staying cozy.

As most babies will be discharged when they are exhibiting stable newborn ability and behaviors, your first three months caring for a preemie need to be treated as the “newborn phase,” regardless of the child’s age. Parents need to take time to get used to the physical around-the-clock effort of being a parent. It is realistic to expect your preemie will sleep more than the average newborn, yet will probably wake at more frequent intervals for feeds.

A lot of what your baby is doing may look random to you, but he or she is actually making small developmental steps every day, such as holding eye contact for longer and longer periods, slowly waking up for calmer and more alert periods, and moving (kicking legs and waving arms) in rhythm to your voice.

Feeding and weight gain is still a critical issue and your pediatrician will be watching weight carefully in your baby’s first two weeks after discharge. If you are bottle-feeding, it is easy to see if the baby is getting enough milk, but if you have transitioned to breastfeeding, frequent weight checks can help ensure that your baby is getting proper milk transfers. There can be challenges when premature babies first start nursing. Ayelet Kaznelson, an IBCLC lactation consultant, comments, “After a baby has been discharged, we can sometimes see a weight drop after two weeks. We really want to ensure good milk transfer, but not all preemies may be strong enough.”

Skin-to-skin contact in the early weeks at home is one of the best things you can do with your preemie. Undress your baby (except for their Pampers diaper), then lay them on your chest with their head on your left side (to hear your heartbeat!), and cover them with a blanket if needed. This “kangaroo care” fosters anti-stress hormones in your premature baby, as well as aiding in neurological development -- and that’s without the tired parent having to do very much! It’s nice to know that this helps them grow and cope, just while gently holding them!

We often worry whether we will be able to care for our little ones, especially when they’re preemies. One of my students, a mother of twins born at 32 weeks, describes the moment at which she knew everything would be okay: “We had brought Annabel home three weeks before little Natalie. When Natalie came home, I remember sitting with both of them on my lap, each only four pounds, wondering how I would ever be able to care for both girls. At that moment, Natalie, reunited for the first time with her sister, rolled into little Annabel’s arms, and I knew we would be okay. We were all together -- we were finally a family.”