Insurance, Part 1

Health insurance is always important however when your baby is in the NICU, it takes on even more importance. Our daughter’s hospital bill was well over $2 million and that doesn’t count doctor fees, procedures or specialists. Here are a few tips to think about now to hopefully save you some headaches later.\

Thirty day rule – once your baby is born you have 30 days to add him/her to your insurance policy. Thirty days may seem like a long time but when you’re worried about many other things that time can pass by quickly.

Double Coverage – if you have the option, have your baby put on the insurance policies for both parents. This will help reduce the costs you have to pay and ensure that your baby gets the most coverage available to him/her. Note: when a baby is covered by two insurance policies, primary insurance is based on the parent’s birthday month (i.e. if mom is born in March and dad is born in November, than mom’s insurance will be primary).

Review your policy – there are several key things to check on your policy:

• Lifetime cap – some insurance policies have a lifetime cap. Check and see what your coverage offers because your baby could easily surpass that just with his/her stay in the NICU.
• Coverage amounts – some insurance covers 100% of some things and then a percentage of other things. Find out what the coverage is in advance so that you can anticipate what you will have to pay.
• Deductible – some insurance policies come with a deductible. Make sure to check and budget accordingly.

Keep track of everything – I’ll discuss more tips for this in the near future. Basically, don’t throw out any paperwork because you don’t know when you will need it. Also, keep a phone log for every time you speak to a customer service agent – write down who you spoke to and when. This could become important if you have to appeal/challenge a decision.

Laundry

Having a baby means doing a lot more laundry. This is true even if your baby is in the NICU. In order to keep patient items separate, most (if not all) hospitals will have you take your baby’s clothes and bed items home to be washed. Blankets, sheepskin, clothes and any other baby specific bedding will be separated and placed in a specific bag for you to take home and wash.

Since baby skin is often much more sensitive than our own, most people advocate using a special baby detergent to launder clothes. To save time and money, some people use regular detergent that is dye and perfume free. If you decide to use a regular detergent, I would still advise keeping your baby’s items separate while they are in the NICU. I’ve created a list of some the major brands that carry baby-specific laundry detergents.

Dreft
Seventh Generation (environmentally friendly)
Method Baby Laundry Detergent
All Baby
Caldera Sweet Pea
The Laundress
Purex Baby
Oxyclean Baby – Stain remover and soaker

Some people suggest air drying the sheepskin bedding for your baby. I would suggest using a drying rack or hanging the sheepskin from hangers in your bathroom. If you have other small children in the house – keep these items away from them as they could introduce new germs that may be harmful to your baby in the NICU.

When bringing clean clothes back from to the NICU, we used perfume free garbage bags. This way we knew the bag was unused and could be closed. Ziploc makes large bags for storage that could be used as well.

Questions

Since most parents can’t be with their baby 24/7 in the NICU, you end up calling in to check on your baby during the times that you can’t visit. Here are some general questions to ask that should give you a basic idea of what’s going on. If your baby is having any specific issues, make sure to ask detailed questions about their status/progress.

Did he/she have a good night/morning/day?
- Hopefully this will tell you if your baby seemed comfortable and content or if something happened to indicate that there is a potential problem.

How much does he/she weigh?
- Keep in mind that babies are normally only weighed once a day (at night) so it isn’t necessary to ask more than once.

Did the doctors say anything when they came by? Are there any new orders for today?
- Doctor’s normally start their rounds around 9am and they check on the most critical patients first. Any new orders should tell you if they are making any changes to things like medicine, feedings, breathing devices, etc.

How did his/her feedings go?
- You should be able to find out if your baby is tolerating feedings or doing well with the bottle.

A word of advice – if you call in and your baby’s nurse is on a break, try calling back when they are done. The relief nurse will most likely only be able to tell you what is on the chart since they aren’t the one watching your baby. Your baby’s regular nurse will be able to provide a full report.

Holding Your Baby

Holding your baby, especially for the first time, is an extremely exciting and special moment. It can also be very intense and nerve wracking when your baby is in the NICU and still very small and/or fragile. I had to wait nine days to hold my son and a month to hold my daughter. With both experiences, I learned a few things that I would like to pass on to hopefully help you in your own experience.

Don’t be afraid to ask – When your baby is born small or has medical issues, making sure they are stable is the first priority. During those first days or weeks, you may think that it isn’t possible to hold your baby. Or that someone will let you know when it is okay. While the nurses all know how important it is for you to hold your baby and will try and facilitate that, it doesn’t always work out. Nurses may assume that you have already held your baby or that someone else has already talked to you about it. If you aren’t sure, ask. Even if you have to wait, you will know what sort of milestones your baby needs to reach before you can hold him/her. As things progress and seem to be getting closer to the holding point, ask again.

Timing – Find out the best times to hold your baby. If your baby is on a ventilator, the amount of effort that it takes to get your baby out and into your arms may require that you devote at least an hour to holding your baby. You may want to time holdings with feedings. The nurses usually prefer to have you hold your baby after they have done their assessment. Ask the nurses about what scheduling times work best for them and your baby. In the beginning you may only get to hold your baby a couple of times a week however as he/she gets older and stronger you should be able to hold him/her every day.

Relax and Focus – When you are holding your baby try and relax. It can be hard as you worry about wires and tubes, how your baby will handle the experience and the general activity around you. Focus on your baby. Talk to your baby about your day, what you are thinking or pretty much anything that comes to mind. Try not to watch the monitors and the numbers. When you are at home you won’t have the monitors so learn to notice your baby’s physical cues for getting tired, uncomfortable or tense.

One thing at a time – When I was holding my son I used to instantly start rocking in the chair (who can resist in a rocking chair) and talking to him. A nurse pointed out that preemies get overwhelmed easily so start with one thing at a time. Once you are holding your baby, let him/her get used to that and then add one thing at a time. If you’re talking, don’t rock. If you’re rocking, don’t talk. After awhile your baby will start to be able to handle more.

Keep It Clean

It has been proven time and again that one of the most effective ways to get rid of germs and keep healthy is frequent hand washing. Babies who are premature are extremely susceptible to any virus or germ so it essential that you stay as healthy as possible. This can become even more difficult when you have small children. Here are some tips and products that can help make it easier to keep you and your kids (and their hands) clean.

Wash Your Hands. A lot. Try and wash your hands as much as possible. If you go to the store, wash your hands when you get home. Wash your hands frequently at work, especially when you go through public places.

Wash Your Hands for at least 20 seconds. That is how long it takes to wash all of the germs off of your hands. Try singing Happy Birthday as you wash your hands to make sure that you are washing long enough. And don’t forget about the top of your hands – they need some cleaning too!

Make It Fun
Kids often do a quick and not very through job of washing their hands. A nurse once told me that she had her nephews make “soap gloves” while washing their hands. This ensured that it took them longer and that they covered the front and back of their hands. We quickly implemented that and now our son loves to make soap gloves.

Companies are now coming out with soap that encourages kids to take longer washing their hands and have fun doing it.

SquidSoap by Airborne – According to their website: “It's the only liquid-soap dispenser with a specially designed pump that stamps a child's hand with vegetable dye. It takes about 20 seconds of thorough hand washing to remove the ink mark, leaving the child with clean hands.” Cool stuff. It’s fun and it helps you know if your kid has really washed his/her hands.

Dial ColorClean – This was featured in the February issue of Parent’s Magazine. This new antibacterial soap has “Timer Beads” that break open while your child washes her/his hands. The beads turn green or blue and slide around so your child really has to work hard to clean the soap off. I love that companies are getting innovative about this kind of stuff.

Hand Sanitizer – Companies like Purell have made hand sanitizers a standard for cleaning hands. Throw a bottle in your purse, diaper bag and car. When your baby comes home, keep a bottle in key areas where your baby will be so that you or your guests can quickly clean their hands. Our son thinks that Purell is fun so we have him use it after he has sneezed, coughed or touched his nose.

Choices
Give kids a choice about what soap they can use. Choose two soaps with different colors and scents so that kids can see a noticeable difference between the two.

Reward/Contest
Create a sticker reward chart for kids to use when they wash their hands. Give them a prize after they have washed their hands a set amount of time. Have a contest to see who washed their hands the most in one day.

Keep Track

Did you know that you can deduct medical-related mileage and medical expenses from your taxes?

If you haven't already, start keeping track of your trips to the hospital or doctor offices. For 2007, the standard mileage rate for the cost of operating your car for medical reasons is 20 cents per mile. That can add up and you should take advantage of it.

• Keep a notebook in your car and list each visit that you make to the hospital. Note the date and where you were traveling from. This will ensure that you keep an accurate record.
• Use your car's trip odometer to track how far away the hospital is from your house, office or anywhere else your routinely travel from to get to the hospital.
• Once your baby is out of the hospital, keep track of mileage for doctor visits as well
• Keep all receipts for medicine, equipment, and insurance co-pays. These expenses can also be deducted from your taxes.

Check with your tax preparer on all guidelines and rules before filing.

Visitors

When your baby is in the NICU, family and friends will naturally want to visit. Keeping these things in mind will help keep you sane and your baby healthy.

NICU rules – every NICU has their own rules about who can visit. Most have a two-person bedside limit with one person being a parent. Some NICUs allow only grandparents or siblings to visit. Others leave it up to the parents. Once you know the rules – please try and follow them. It makes it easier on everyone.

Preparing Visitors. Visiting a baby in the NICU can be an overwhelming experience. Here are some steps you can take to help make the visit a better experience for everyone involved.

Your baby – if your baby was born very small or with a lot of issues, prepare your visitors for what they will see. Let them know that there are a lot of machines, wires, and tubes hooked to your baby. Show them a picture (if possible) so that they have an idea of what they will be seeing.

The NICU – let visitors know that when they go into the NICU rooms, they need to act is if your baby is the only baby there. People are naturally curious about babies and given the openness of most NICUs, this idea can be really hard to understand. Explain that patient privacy is important and this rule is in effect for everyone.

Being Healthy – Everyone you know will be excited to see your baby. As the parent, you need to make sure that everyone realizes that keeping your baby healthy and germ-free is important. People have different ideas of what healthy means – maybe they were coughing earlier but now they are fine. Or their kids are sick but they don’t have a cold. If someone has experienced cold symptoms or has recently been exposed to someone with a cold, they should wait to visit your baby. This can be really hard to explain but if a baby gets an infection, it can be fatal. I got two colds while my daughter was in the NICU and as much as it hurt, I didn’t get to see her for 7 days while I got completely healthy.

Washing – Most (if not all) NICUs require you to wash and scrub your hands before entering. Make sure that all of your visitors do wash their hands. If the NICU has a suggested time limit – try and stick to it. This will help keep your baby healthy.

Timing – Try and space out visits/visitors so that you don’t have a revolving door of people coming to see your baby all at once. This will make it easier on you and the nurses who have to get their work done while you are there.

Interaction – Depending on what is allowed for your baby, encourage visitors to talk to and/or touch your baby. This interaction may be determined by your baby’s status or by you. Make it clear ahead of time so that people aren’t surprised when they get there.

Reading Stories

One of the best things I did for my daughter (and for me) while she was in the NICU was record myself reading her stories. The nurses would play the tape for her when she got fussy or when she was ready to take a nap. I felt good knowing that even though I wasn’t there, my daughter could still hear my voice.

I wanted something fairly inexpensive and easy to use so I found a Sony Clear Voice Cassette Recorder. They also sell digital versions that look quite cool.

As for books, honestly you can read anything. I’ve listed some of my favorites below for a starting point. Amazon has a list of baby books with some fabulous suggestions on it. You can also get the whole family involved. While I was recording the stories my four-year-old came in so the tape has him saying hi and I love you to his sister. It was very sweet and made me smile every time I heard it on the tape. If your kids are older – have them read a story or two as well.

Favorite Books:

Goodnight Moon, Margaret Wise Brown
The Very Hungry Caterpillar, Eric Carle
The Runaway Bunny, Margaret Wise Brown
Guess How Much I Love You, Sam McBratney
Harold and the Purple Crayon, Crockett Johnson
Corduroy, Don Freeman
I Am a Bunny, Richard Scarry
The Olivia Series, Ian Falconer

Reading to your baby doesn’t have to be limited to a tape. You can also bring books into the NICU and read them while you are sitting there or holding your baby. I did this too - it was a nice way to connect with my baby and sometimes I simply ran out of things to say or I was too tired to think of something.

Happy Reading!

It's all about timing

Visiting your baby in the NICU can be an exciting and sometimes frustrating experience. Learning about a couple of key timing issues can help make visits or phone calls much easier and more relaxing.

Reporting/Rounds – Most NICUs have specific times during the day that the NICU is closed to visitors. These times are used for doctor rounds or nurse reporting during shift changes. Due to HIPPA regulations and the openness of NICU units, it is essential that the NICU is closed during those times as the doctors and nurses are discussing multiple patients. Those times should remain consistent so once you know what they are; it’s easy to plan around them. Doctors routinely write orders in the morning so calling after those rounds is a good time to find out if any changes are going to be made for that day.

Shift Start Times – Find out if nurses work an 8 or 12 hour shift and when those shifts start and end. If you are calling in to check on your baby and how he/she is doing, find out what time nurses start and then wait at least an hour before calling. This will give your nurse time to settle in, check on your baby and provide up-to-date information about how your baby is doing.

Assessments – Nurses run on a pretty regulated schedule. Assessments are the times when they check on your baby’s temperature, do a diaper change, listen to their lungs, change leads or wires, etc. Find out what time your baby is scheduled for assessments – they are commonly done around feeding times. This is important for two reasons – if you want to know exactly how your baby is doing, what his/her weight is (usually done once a day) , and how much they have eaten so far, it is best to wait until after that assessment is done. It’s also easier on the nursing staff if you give them time to complete those assessments before calling. Also, it is important for parents to participate in some of those activities –specifically taking your baby's temperature and changing his/her diaper. You can plan your NICU visits around those times so that you can participate and be involved as much as possible

Feedings – Obviously you want to be there for as many feedings as you can – especially if your baby is old/strong enough to nurse or take a bottle. Work with the nurses to plan out which feedings you can be at so that they can make sure that those are the times that bottle/breast feedings are done (vs. just being fed through a tube).

Decorating

When your baby is in the NICU, making their isolette or crib as “homey” as possible is important (and can be fun). This can be a challenge when your baby is surrounded by tubes, wires, and beeping machines. Each hospital has their own specific rules as to what is allowed so check with them first before bringing stuff in. Here are some ideas for what you can do:

1. A family picture – Bring in at least one photo of your family. If the picture is going in an isolette, I would advise putting the photo in a Ziploc bag because sometimes medicine or feedings can spill and this will keep it dry.


2. Message for your baby – Write a note of love, hope or inspiration to your baby. Anything that makes you feel better or happy. Put up a bible verse or favorite poem.


3. Nametag – If your hospital doesn’t make nice nametags for each baby, whip out some scrapbook supplies and make one yourself. Or use some paint or print something out on the computer.


4. Small stuffed animal – Bring in something small that doesn’t take up a lot of room. When our son was in the NICU, my sister brought a Kermit pencil topper. We took pictures of our son with the pencil topper and it helped show his growth over time.


5. Mobile – If your baby is in a crib, bring in a mobile. Our daughter absolutely loved this one. It helped her go to sleep and soothed her even among the noise of the NICU


6. Blanket – Many hospitals put blankets over the top of each isolette to block out light and noise when babies are sleeping. Make or buy a special blanket for your baby and ask the nurses to use it.

The Importance of Folate

If you are pregnant, thinking about becoming pregnant or know someone who is pregnant, you may have heard about adding folate/folic acid to your diet. Why is it so important? According to the U.S. Public Health Service, if all women of childbearing age consumed 400 micrograms of folic acid daily – before and during pregnancy – it could help up to 70 percent of pregnancies affected by neural tube defects (NTDs), serious birth defects of the brain and spine such as spina bifida and anencephaly. For more information, please visit the March of Dimes

So what does it take to get 400 micrograms of folate/folic acid? Today most whole grains that you buy in the store are fortified with folic acid. In addition, many fruits and vegetables are a good source of folate. So basically, it's really not hard to get plenty by diet, as long as someone likes grains and fruits/vegetables.

Excellent sources of folate:

• Greens such as romaine, spinach, turnip greens, mustard greens, collard greens
• Asparagus, broccoli, cauliflower, and beets

Very good sources of folate:

• Dried beans like lentils, pintos, black beans, kidney beans, navy beans, garbanzo beans
• Brussel sprouts, green beans, summer squash, cabbage, fennel, bell peppers, green peas
• Papaya

Good sources of folate:

• Cucumbers, leeks, winter squash, eggplant, onion, corn, avocado, and carrots
• Tomatoes, oranges, strawberries, raspberries, cantaloupe and grapefruit

If you aren’t sure how much to eat in order to get the right amount of folate, check out this sample menu below. The menu was prepared by a registered dietician.

Breakfast: 2 slices of toast with peanut butter, 1/2 grapefruit, milk
Lunch: spinach salad with garbanzo beans, chopped egg, tomato, pea pods, cheese if desired, plus 2 slices of bread and milk;
Snack: graham crackers and cheese and a banana;
Dinner: chicken, rice, asparagus and milk;
Snack: orange

If a pregnant woman were to eat the above foods, she could get over 600 mcg of folate, and still have a lot more calories left over to indulge in other foods. Basically, eating 2-4 fruits a day (1 piece or 1/2 cup), 3-5 veggies (1/2 cup cooked, 1 cup raw), and at least 6 grains (1 slice or just one half cup) would give someone a good bit of folate each day. Adding cooked dried beans each week really helps too.

Recording Your Experience

Your baby’s time in the NICU is important and full of milestones, firsts, procedures, and issues that you and your baby will experience. Here are a couple of ideas for documenting these things while your baby is in the NICU

1. A Photo A Day – With our son we took at least one picture of him every day that he was in the NICU. A lot of the pictures are similar however it allows us to look back and see how he progressed and remember those experiences. Even if you can’t do a photo a day, try to take regular pictures of your baby so you can watch him/her develop. I would highly recommend buying a disposable camera and keeping it at your baby’s bed/isolette so that if you forget your camera, you can still document an experience as it happens.
2. Journal – Write down the big and little things that your baby (and you!) experience in the NICU. A couple of years after our son was born I went back to do a scrapbook of his NICU experience and realized that there were some things that I didn’t remember when they happened. So for our daughter I kept a daily journal of what was going on. Sometimes it was just a recording of her weight and how she was doing. Other times were longer entries about things that happened or how we were feeling. I love that I have something detailed to look back on as the years go by.
3. Calendar – Carry a small calendar in your purse or pocket. When something happens to your baby – blood transfusion, milestone weight gain, first bath, etc. you can write it down on the day it happened. That will give you an easy way to record and remember when things happened.

There are many ways to document your babies NICU experience – just pick something that works for you.

Pumping, Part 2

Keeping up a solid pumping schedule at home can be hard enough however once you go back to work – it can get really difficult. When I went back to work I often found myself in meetings when I should have been pumping or putting it off so that I could finish a project. Working out a schedule and then sticking to it at work is hard but can be done. Here are a few tips for keeping on track and recommended products to pack in your pumping bag.

• Discuss your pumping needs with your supervisor as soon as possible. Make sure they understand your plans and how important it is to you and your baby. Being at work may mean that you have to alter your pumping schedule slightly but frequency is most important so try and stick to a similar schedule as much as possible.


• Find a place to pump. This can be difficult depending on where you work. You need a place that guarantees privacy, has a place to sit and ideally an electrical outlet. I was offered a conference room however even though the door locked, I didn’t feel 100% comfortable that people wouldn’t try to interrupt. As strange as it may sound, I ended up pumping in a storage room. It had a lot of extra room, good lighting and there was only one key so I knew that no one would interrupt me while I was in there (because really, who wants to go to a storage room?)


• Making time. This can be the most difficult part of pumping at work. Since I end up in a lot of meetings, I finally put pumping time on my calendar. I marked those times as important so people knew not to schedule anything during that time. Knowing that I had that on my schedule (along with the handy reminder that would pop up) made it much easier to stick to my schedule.
  
  What to pack:


• The pump (obviously). For women who have premature babies and may be pumping long term (or any women who is pumping long term), choose a double electric breast pump. This will save time and ensure that your milk comes in sufficiently. Most hospitals offer a breast feeding store/center that can help you purchase one. Stores like Target and Babies R Us also sell some. The two most popular are “Purely Yours” by Ameda and “Pump In Style” by Medela. I’ve personally used the Ameda one and it was great however I have heard good things about the Medela one as well. Make sure your pump comes with a battery pack or battery option just in case you end up in a location that doesn’t have an outlet.


• Milk storage. Make sure you have a supply of storage containers or bags at all times. Some NICUs will provide plastic containers for storage and others don’t. Even if your NICU offers containers, I would recommend buying bags to have on hand for emergencies. They take up less room than the containers so you can easily throw them in your bag. Medela, Gerber, and Lansinoh all make good milk storage bags. Storage tip for bags: when you put the bags in the freezer – lay them flat and stack them on top of each other. You can hold a lot more bags that way. If you are going to be pumping long term and especially if your baby doesn’t eat a full feeing right away, I would highly advise investing in a free standing freezer. We borrowed one from a friend and it was great.


• Cleaning products – Obviously you need to wash your pump parts after each session however sometimes at work it is tough to find the time to do a proper job. Medela makes two great “Quick Clean” products – the Micro Steam bags and Wipes. The wipes are especially great at work since you don’t need water. Just the wipes. The steam bags are great even for at home use. A lot of hospitals advocate sterilizing your pump parts with boiling water if your baby is in the NICU. If you can do that – great. If you just don’t have that kind of time, the steam bags are an excellent alternative. You put the parts in the bag, use a tiny bit of water and a few minutes later – your parts are clean and sterile.

• Something to do – now you may bring work with you when you pump. I did. For good measure, I also threw in a Sudoku book and a daily NICU journal (more on that soon). And a pen. That way I wasn’t stuck there just waiting for my time to be up.


• Milk labels – Most NICUs (if not all) require your milk to be labeled with specific patient labels. Keep some in your bag so that you can date/time the label and put in on there. That way you know the label is there.


• Refrigeration – If you are pumping and then using the milk that day or the next – I would recommend an insulated lunch bag or bottle carrier. It can go right into the refrigerator and makes it easy to carry home. If you are pumping and then freezing the milk for later use, then the milk should go directly into the freezer. I used paper lunch bags to store the milk bags or bottles at work and then brought them home in an insulated lunch bag with freezer packs.


• Nursing pads – If you need them, bring extra just in case.


• A bag to hold everything. Both Medela and Ameda sell their pumps with a bag at extra cost. If you can do that option – go for it. If not, most hospitals send you home with a diaper bag. I used that both times and it was great. I didn’t feel guilty if it wore out or things spilled because it was free to start with. They usually come in black which makes it great for work. If you don’t get one or want to use it as a diaper bag, then any large bag will do. I recommend a backpack or bag with a zipper – it makes it easier to keep things private.