But I'll Survive

I have spent 8 days on a Transitional Care Unit at St James' hospital in Leeds with my premature, jaundiced baby. We're 1-2 days away from going home, pending his blood results today, and it has been one of the most challenging experiences of my life.

The staff are amazing - so supportive and there day and night to help you establish breast feeding if that's your choice, or to help you formula feed through a bottle, cup or nasal tube (even feeding your baby at night for you if you need sleep) if you can't or don't want to breastfeed.

There are different staff every 12 hours so depending on the length of your stay you will get mixed advice, something I've appreciated because I already had strong views and an arsenal of my own research and network of support established so I could take it with a pinch of salt and pick and choose what worked for us. Some of the mums have literally changed tactic with every shift change and are really struggling and frustrated as a result.

It's also the brightest, loudest place on earth. You will find that you and your baby filter out the cries of other babies, the shush-slurp of breast pumps and the humming of jaundice machines but the "unnecessary" noise from the nurses and other mums on the ward will drive you stark raving insane if you need sleep or are trying to settle your baby.

Top noise complaints:

Mobile phones. Some people talk on them too loudly, have the sound turned up so much you can hear the person talking to them, have obnoxious ringtones, have keypad tones switched on loud... you name it. If there are teenagers on the ward then you'll also get to hear them watching stupid videos on YouTube, and if men are watching the football match on their smartphones you'll get to enjoy that too. If you need to make/take a phone call, either speak in an indoor voice or take your phone out to the hall. And whilst having an alarm set for feeding times is fine - your phone is no more than a foot away from you and you're hypersensitive to noise in order to pick up on your child's cues. You can have it on vibrate or low volume - it's not necessary to wake the whole room.

Rustling bags and zips. It's understandable that there will be the odd rustle of a nappy packet or opening sterile syringes and the like, it's a hospital, but never ever ever ever bring carrier bags on a Trans ward. If someone brings you a gift or laundry etc then unpack it during the day and put away in your hospital bag or on your chair/in your locker. At 2 in the morning when you've just settled a baby and someone in the next "cell" starts rooting for breast pads in a Boots bag - trust me. It's not white noise that you or a baby can sleep through. If you don't have good luggage, the BEST bags for hospital are those fabric/hessian bags for life. They carry loads, make no noise and can be stacked under your bed/chair out of the way really easily.

Hazardous waste bins. Hospital bins are made of metal and opened with a foot pedal. DO NOT open it and allow it to bang shut. Depress the foot pedal gently to ease it back down. It is ridiculously inconsiderate to bang it shut when people and babies are sleeping - whether during the day or night.

Visitors. There is a concept called "indoor voices" that you must learn. When someone is sat in your "cell", a foot away from you - you can speak in gentle tones so that everyone else doesn't 1) hear your entire conversation 2) can sleep through your entire conversation. When children come into the ward, if they scream or go mental, take them out in the hall for a bit of a time out, or take them to the day room where there's space and a television. Don't just let them carry on like you might at home. You're not at home - you're in a room of desperately sleep deprived women and sick babies.
Children are not easy to make behave in special circumstances, it must be hard for them to see their parents in hospital and be confusing having a new sibling - especially one hooked up to machines but be considerate of the other people in the room trying to sleep or settle a child and at least make the effort to ask them to be quieter or take them out.

There are number of things that you will need whilst you're here.

Fresh clothes and pyjamas. You will be covered in blood, sweat, breast milk, possibly baby poo and urine and you're trapped in a stuffy room where the windows do not open, full of other people. Have access to as much clean underwear and loose, comfortable clothes as possible. If you're breastfeeding you'll have lots of nakey skin-to-skin time but make sure your pyjamas or nighties are cool and strappy and can just be pulled down when you need to. If you have an eyemask then it will be your best friend - the ward is never dark - it's floodlit during the day and dimly lit at night but you can see the light over your curtains and inevitably someone will be awake in the cubicle next to you with their light on - or there will be jaundiced babies on uv machines that are essentially sunbeds! On day 7 I got a bandana to tie round my eyes and promptly got 4 hours sleep split into 2 hour sessions. Best. Feeling. Ever.

Breast pads, nappies and sanitary towels. More than you could have ever thought possible. Take 5 packets, take 10 packets. They have spares on the ward but don't rely on them filling up the cupboards regularly or there being staff available to fetch you them.

Snacks and drinks. If, unlike me, you eat hospital food instead of having your own meals delivered then you will find your stay quite easy from this perspective - but if you're breastfeeding you'll need more than 3 meals a day and you'll need good food. I had cereal, both dried and fresh fruit, crackers and healthy biscuits and flapjacky things, nuts... The 11pm and 2am feed are usually the ones you need access to snacks for. ESPECIALLY if you're not sleeping. There are no facilities for you to get your own water so don't rely on them bringing you a fresh jug 3 times a day when they're busy. The ward is hot and if you're breastfeeding you'll need at least 4 litres of fluid a day. Nag them for more water or do what I did and get a litre bottle every day of your own in addition to the jug - and some juice!

Fenugreek and breast stimulation. If you're on a Trans ward, chances are you had an induction or a c-section or an otherwise non-standard vaginal birth and haven't had the luxury of immediate skin-to-skin or even access to your baby after birth for much of the first day. This really delays your colostrum coming in (your actual milk will follow on average about 3 days later but if you want to breastfeed from the get-go without them using formula (very rare that you can give them everything they need straight away - the nurses would still likely top them up through a nose tube with high-calorie formula) you need a helping hand. Fenugreek is a miracle. Take 2 x 610mg capsules three times a day and if your colostrum hasn't started flowing within 24 hours then I'll eat my own cervix. On the first day, they really should advise you to begin massaging your breasts and trying to hand express to get things moving. Don't worry though - I wasn't allowed any skin to skin or told to do this until day 2. The Fenugreek helped enormously to make up for lost time and even if it takes weeks, you can always pick up breastfeeding later. It often feels like you're never going to get anywhere but you will be astounded by how quickly you hit those milestones and how quickly you both learn to work together. The staff should be a great support when you're tired and overwhelmed and need guidance to decide on positioning and suchlike, but preparing beforehand by reading La Leche League's Womanly Art of Breastfeeding and Ina May Gaskin's guide is really helpful. Your baby will decide what position he favours for each breast - as long as their head is in line with their tummy and they can move their neck to breathe you can have them tummy to tummy horizontally, vertically or diagonally in a "rugby ball" hold. Keep your shoulders down and sit up straight to avoid burning and cramping shoulders.

Sleep. The idea of sleeping when your baby is sleeping is the soundest advice that you will ever get. You'll have time for a shower and to eat but shouldn't commit yourself to doing anything else for the first week after they're born. Babies start out on a 2 hourly feeding/changing schedule, then within a few days it goes to 3 hourly and after a week it can go up to 4 hourly, but it's baby-led for breastfeeding.
On a trans unit if you aren't proving that they're weeing and pooing and feeding according to this timetable and your baby loses 8% of his weight then you aint going nowhere and if they need to top him up then it interferes with your breastfeeding routine and can be really disheartening.

I'm demand breastfeeding which involves feeding as often as he needs, but he started out well bedded into a routine and was gaining weight perfectly until he got jaundice. He feeds now for between 45 minutes and an hour and 15 minutes every 2 hours (like clockwork now that he's less jaundiced and has some energy) though one of his feeds is usually 20 minutes of hind milk (if he didn't completely drain my boob before it's time to swap to the next one).

Imagine sitting or reclining in the same position for over an hour, monitoring them to make sure they have a good latch, are still sucking, need burping, stimulating them when they start to doze, gazing into their eyes... it's hard work. Wonderful, but hard. If you haven't slept you're going to struggle enormously and if you're working at establishing feeding on no sleep then hoo boy are you in for a rough time.

Being considerate to those around you will hopefully encourage them to do the same. In a room full of people at different levels of progression, on different routines... it's hard to find an hour to sleep without someone disturbing it and all you'll want to go is get home where you can be as quiet or as loud as you like - as frustrating as it is when you're trying to sleep and someone else is being loud - it's also stressful when it's your baby who does a giant poosplosion and shatters the silence with his screaming.

Build a relationship with the staff. You will never survive without them on your side. I was lucky to have such amazing support, but there was one member of staff that took an immediate disliking to me - refusing to give me my right to skin-to-skin, telling me I'd be no good at breastfeeding (seriously - she was a JOY), ignoring my requests for water (as per my birth story, I'd been sick more than 10 times in 12 hours and recovering from anaesthetic...  I needed water) ignoring my request to have my pointless catheter and empty cannula tubes removed on day one because my husband was banned from the ward so I was on my own and I couldn't get up from the bed to pick up my baby or hand express with tubes sticking into my wrists...
I will be putting a complaint in about her, but everyone else has my eternal gratitude for their support and advice and encouragement. I worked my arse off this week to get feeding established and survive in this hugely challenging environment - not an easy thing when you have OCD, a sick baby and haven't slept - and being told how fantastically well you're doing at 4am when you just want to curl up in a ball and die is very welcome indeed.

Ziggy played guitarrrrrraaaaarrrrraaaarrrrrr.
Title: Survive by David Bowie