Play PodcastPlay Download PodcastDownload

Transcription:

Bill Klaproth (Host):   St. Joseph’s Health Hospital is celebrating the 50^th anniversary of its neonatal intensive care unit, or NICU. In 1970 St. Joseph’s was the first hospital within 50 miles of Syracuse to open a preemie care center for infants experiencing health challenges. Since then the hospital continues to balance family centered maternity services with the technology and services required as a level three prenatal center. In this episode, we’re talking about how moms can try to prevent premature birth, but if it does happen what parents can do to cope with the stress of having a baby in the NICU. So let’s learn more with Dr. Christopher LaRussa, an OBGYN, and Dr. Jonathan Chai, a neonatologist and director of newborn service at St. Joseph’s Health. Dr. LaRussa and Dr. Chai, thank you both for your time. Dr. LaRussa, let’s start with you. When a woman thinks that she’s pregnant, what’s the first thing she should do?

Christopher LaRussa, MD (Guest):   Well that’s a great question. A lot of women worry when the moment when the get pregnant what did I do? What have I done this past short while that I shouldn’t have done, and they start to think a lot of bad things. I think the first thing you can do after confirming the pregnancy is to just simply pick up the phone, call the office to let us know that you're pregnant. We can kind of figure out about how far along you are. Our nurses are trained and even our telephone people to quickly ask some of the more common things. Are you on any medications that maybe you have questions about? Do you have any other medical issues that maybe we would want to know about so that we could see sooner or later. I think the general statement women should not immediately stop all of their medications. Ideally they would have already been taking a prenatal vitamin, but if not they would want to start that. Then it’s more just common sense things. Think about what other risks you may have, health risks as well as maybe habits. Some of which may not be good habits that you would want to try to address and make sure that we’re aware of. Just generally take good care of yourself. Pay attention to what you eat, continue exercising so to speak, and then let us see you within generally a couple weeks or so—two to three weeks depending on when they're calling. So they’ve had some time to do a little bit of research and we have some time to catch them early. Then we can address some of their concerns and questions more pointedly.

Host:   So the health of the mom is number one. You did mention taking a prenatal vitamin. Can you talk a little bit more about that in the importance of taking a prenatal vitamin?

Dr. LaRussa:   Well vitamins are very important. Like I just stated, women ideally should be on vitamins at least a month before they would decide to start trying to conceive. It’s just because a lot of us potentially aren’t eating as well as we could. Prenatal vitamins have a lot of important things that even a very small early pregnancy would benefit from. Iron, which is more for the mom, but is also very important for the baby. The folic acid is very important. That’s why most vitamins in general that are over the counter will have a higher amount of folic acid, which is what women need because women of childbearing age need a higher amount. So making sure women are taking that vitamin is important, ideally from the beginning. It’s in some studies been associated with a lower incidence of babies that are small for gestational age, which means they're too small for what they should be as they're developing. The omega-3 fatty acids are important as well. Then, like I said, they have other things that pregnant women need more. So a prenatal vitamin is very important, and I would say is probably the number one thing women could do as they are considering pregnancy and definitely in the early first trimester.

Host:   Okay. Well that’s really good to know. Then preterm birth can't always be prevented, but moms-to-be can help lower their chances of going into labor too soon. So what are some of those things they can do Dr. LaRussa?

Dr. LaRussa:  Well some of the things we’ve already talked about, which is just maintaining their health and managing any other medical issues, taking the prenatal vitamin. Probably one of the most obvious things is keeping your regularly scheduled appointments and actively engaging in your medical care so that you can discuss ongoing issues that may be developing. You're checking women’s weight gain, you're checking their blood pressure and making sure that their weight is good, they're exercising, they're eating a good well balanced diet. If they're admitted to smoking or other elicit drug use or drinking occasionally, you can kind of follow that because those are hard habits to break, even when you're pregnant. Just things in general to reduce the stress in your life. So exercising we’ve already said is important, trying to get as much sleep as you can. All of those things are shown to be very beneficial. I think it’s intuitive for most women, but all of the food choices and dietary challenges a lot of us face now. Really watching what you eat is also important.

Host:   So speaking of those food choices, I often hear things like don’t eat raw meat or fish or stay away from unpasteurized cheese. Don’t change the cat litter. All of those things you shouldn’t do. Can you talk about those a little bit?

Dr. LaRussa:   Well those concerns probably center around the infections that also you're potentially putting yourself at risk for. So my women tell me they haven’t been to a deli in months. It’s the cross contamination between the unpasteurized cheese and some of the parasites that can live there. It’s the parasites and bacteria in the undercooked meats, especially raw meats. So sushi is out, the raw sushi. When it comes to cat litter, you don’t have to be obsessive or over the top, but there is a parasite that outdoor cats carry and can bring in the house. So in all cases, even with the cat litter where you're just limiting changing it only when you absolutely had to, it’s just good hand hygiene. Washing your hands. Just common sense things. Those are mainly to reduce the infections that pregnant women and the baby especially are uniquely susceptible to during the pregnancy.

Host:   All of those are really important points to remember and thank you for that Dr. LaRussa. Dr. Chai, let’s turn to you now and a few questions for you. So having a baby is life changing. Having a baby in the NICU is life altering. How can parents avoid letting stress and anxiety take over as they find their footing in the NICU?

Jonathan Chai, MD (Guest):   The NICU is definitely a very intimidating place. It can be really hard for the parents to see past the monitors and the wires and the tubes that sometimes have to be there for the baby to actually see their baby. It’s important to know that even the smallest babies, even babies on respiratory support ventilators can be touched and held by their parents. That’s very, very important. We very much promote what’s called skin-to-skin contact, putting the baby’s skin up against the mom or dad’s skin. That’s been shown to improve bonding. It actually reduces parental stress. It improves mom’s milk supply if she’s breastfeeding. It actually helps babies as well. It reduces their pain responses. It improves their vital signs and improves their growth.

So the other thing that we promote in our unit is making sure that the parents are as involved in decision making as possible. We have daily rounds where we get our nurses and practitioners and the physicians and other staff together, talk about the babies, report on their results, and make a plan for the day. We invite the parents to be involved in that. So they participate right there with us. That’s very empowering to them and I think that helps.

Host:   Yeah, for sure. They want to be involved as well. So you were mentioning how important that skin to skin bonding is. Is that possible with a medically fragile child? You were talking about how daunting it is to see your child hooked up with wires and tubes. How do you do that skin to skin? How do you bond with a medically fragile child?

Dr. Chai (Guest):   Again, we very much promote that. We try to do it if possible. It’s not always possible, but as long as the baby is stable we will try to do it as soon after the baby’s born as feasible because we know that early contact with the baby has really lifelong effects on bonding later on. We would just try to work around the apparatus that the baby’s hooked up to. We get the parent by the bedside and we just carefully lift the baby to them. We can snuggle them in. Even if they're connected to a ventilator, we can get them with the parent that way.

Host:   Then when it comes to this bonding, can you talk about bonding via touch, hearing, and smell and the best way for parents to engage with their baby that way?

Dr. Chai (Guest):   Yeah. So we teach the parents the best ways to interact with the baby. Certainly, skin to skin is the first and foremost, but there are other techniques that we teach them. Babies appreciate more of a steady gentle pressure rather than stroking. Stroking can be a little bit over stimulating. So we teach them that. They recognize parent’s voices. So parents should talk to them. They can play quiet music. They certainly are going to learn the parent’s smell as well. Definitely discourage any perfumes or colognes. They want to just get the parent’s natural smell.

Host:   Yeah. Using all of those senses sounds like is really important for bonding then. I love how you say you go the extra mile to make sure the parent can do that even with a medically fragile child. So then when parents are getting ready to leave the NICU, what sort of support do parents receive from your staff when they're finally getting ready to leave the NICU?

Dr. Chai (Guest):    Yeah. Well hopefully through the whole hospitalization we’re getting the parents as involved as possible. We want as much of the baby care as the parents feel up to doing, we’ll encourage them to do. Certainly as we get closer to discharge, we’re going to expect them to do more and more of it. We often will offer what we call an overnight stay. So we have a special room where the parents can actually come and stay with the baby in the room for a night or two before going home so they can kind of get a little bit more used to being the main one taking care of the baby, but the staff are right outside the door if they need help. We have a whole series of education things that we go over with the parents to make sure that they're properly educated on all of the care aspects before we go home. Then we certainly set up all of their follow up appointments and go over that with them before they go.

Dr. LaRussa:   I’d like to add one more comment. One thing that I was impressed with when I came to St. Joe’s—and I've had many babies come through that intensive care unit. Some of which were even family member’s babies. They have a yearly kind of an anniversary celebration. I know they maintain a lot of contact with these families to continue to support them even months and months down the road and even years later. So I was very impressed with. I don’t know how many other hospitals offer that level of follow up aftercare as well. So I wanted to make sure everybody knew that.

Host:   Well I'm very glad you added that in and said that Dr. LaRussa. That’s good to know and important to know how you feel as well about that. So Dr. LaRussa, let’s stay with you. Last question for both of you. How important is it for mom’s to practice self-care?

Dr. LaRussa:   As far as self-care, just being more aware that—and Dr. Chai said this a moment ago—other than the stress of the NICU baby being life altering. Bringing a new baby into your home is obviously life altering, even if it’s a full-term healthy baby. So what I stress with my patients is as soon as they feel up to it—within whatever’s reasonable, even with c-section patients—it’s trying to help them resume or maintain some semblance of I hate to say the normal life, but the prebaby life. So finding ways to do things with yourself. If that’s this time of the year where the weather’s changing, getting out and just walking around the neighborhood or going on a drive for no reason at all. Coming to your visit and then going shopping at the grocery store to pick up stuff for your baby, although necessary that’s not doing something for yourself. So I encourage women to try to engage in their hobbies again. Maybe meet their girlfriend’s out for lunch, not just women that are mom’s necessarily. Just try to find your old life so to speak so that you're not overwhelmed with 24/7 being a parent. I don’t know many patients at all who don’t understand that it’s not that hard to find that balance. Some people just inevitably get overwhelmed and need a little more care, but I think most people will intuitively want to go back to doing those things. Then they're going to be happier. They're going to be a better mom, a better wife, a better partner. So I think it’s kind of the same things that we would all know that we would want to be able to do to a degree.

Host:   Right. That makes sense. Dr. Chai, let’s bring you in on this question to talk about how important it is for mom’s practice self-care.

Dr. Chai (Guest):    Yeah. I think particularly for moms that have a baby in the NICU and then that baby may be in the hospital for several weeks. Sometimes we see that the parent’s have a hard time letting go and taking time for themselves, that they want to be there 24/7 for the baby. Then they get burned out and exhausted. You can't really care for someone else unless you're also caring for yourself. So we watch for that and we try to encourage them to get out and take time for themselves. Another thing that is just specific to moms that are breastfeeding, it is important to make sure that you get good rest, good hydration, and good nutrition to be able to provide for the baby.

Host:   Right. That overall message you have to care for yourself first so you can care for your baby. Great thoughts today gentlemen. Thank you both very much for your time.

Dr. LaRussa:   Oh yeah. We’re glad to have been here and it was informative for me too. I like hearing Dr. Chai tell us what goes on in our NICU.

Dr. Chai (Guest):   Alright thanks. Have a great day.

Host:   That’s Dr. Christopher LaRussa, an OBGYN, and Dr. Jonathan Chai. For more information, please visit sjhsyr.org/women. That’s sjhsyr.org/women. If you found this podcast helpful, please share it on your social channels and check out the entire podcast library of topics of interest to you. This is St. Joseph's medcast from St. Joseph's Health. I'm Bill Klaproth. Thanks for listening.