Caesarean preparation, gastroschisis and small babies

February 2, 2011 8:03 AM

What should I be doing now to prepare for a c-section in approx. 10 weeks' time? And please share your experiences of having a baby with gastroschisis and/ or who is very small.

I'm 28 weeks' pregnant, and my baby has gastroschisis so I will be having a caesarean. What should I be doing now to prepare? Also, due to the gastroschisis my baby is small, though growing well and otherwise very healthy and active - what are your experiences of having a very small baby? I have excellent antenatal care and my postnatal care should also be very good, just looking to have as much information as possible in preparation. Thanks.

posted by goo to health & fitness (24 answers total)

Oh, and - any experiences of breastfeeding a baby after neonatal abdominal surgery particularly welcome. I still hope to breastfeed.
posted by goo at 8:09 AM on February 2, 2011

Fellow preggo here! Just wanted you to know that there's an entire board for moms with babies with this condition on babycenter.com, and many people have asked questions with answers here about gastroschisis throughout the years, so you can get a feel for what does and doesn't work! Hope this helps and good luck to you and your little one!
posted by 2003girl at 8:13 AM on February 2, 2011

Our twins were both about 5 lbs when they were born (full term at 37 weeks). The first problem -- and this is to be expected for small babies -- is that they had difficulty maintaining their body temperature. They spent their first week in the NICU. My wife and I didn't find the experience too scary, but it can be difficult for some parents. The second problem we almost ran into was that they were just barely big enough to fit into their car seats when we took them home. Check your car seat's ratings for baby minimum weight/length requirements. The NICU nurse wasn't going to let us leave if the kids didn't fit in their seats.

After that, I can't say there were any difficulties or major differences between having small babies and our more average-sized third child (that I remember, at least -- the extreme sleep deprivation from caring for twins wiped out most of my memory from that early time). You will probably need to stock up on some preemie diapers (you can easily find them at Target, etc.)

Good luck!
posted by puritycontrol at 8:18 AM on February 2, 2011

I've had three c-sections. It helps to have a stool or chair in the shower for the first week or so. It's hard to stand long enough to take a whole shower after all of the standing and walking to get ready to get in the shower. Also, a shelf or table for shampoo and soap and things near the shower because bending over is hard. Lots of pillows in bed to put under your stomach to lay on your side or to put under your knees. In my experience, the pain is bad for two or three days, annoying for a few more days and then, after a few more, it's mostly gone, you just feel crappy and tired for a while. Other than that, have someone help you get up out of bed or off the sofa and get someone else to change baby diapers for a week or so. (It's hard to stand up and bend to change diapers, too.) You will need baby oil to get all of the tape and glue from bandages off of you. Nothing else will get it off. (It seemed like I was sticky for weeks after my first baby until I tried baby oil.)
posted by artychoke at 8:20 AM on February 2, 2011

I've had two c-sections and I can't say enough about the Belly Bandit. Get two - one for immediately after and one for when you start to shrink- they really help you feel like your insides won't fall out. Also, Depends undergarments rock. No lochia leakage! Bring scissors to cut them off so you don't have to bend as much. Good Luck!
posted by PorcineWithMe at 8:43 AM on February 2, 2011

Keep on top of your pain meds, especially for the first week after the surgery - don't wait until you're in pain to take something. I had a little notebook where I tracked all of my meds (vicodin, ibuprofin, colace) since they were all on different schedules and I was in such a haze with everything going on that I needed the reminder. You'll probably be in the hospital for 3-4 days after the surgery so take advantage of the nurses there and ask for any and all help you need.

You'll want a supply of granny panties in a large size. The elastic needs to be either over or under the incision (I much preferred over) not ON and there will be a lot of swelling still in the first week or so. Big underwear that you can throw out after you heal will be a godsend. The couple of weeks after you give birth will entail lots of fluid. EVen if you have a c-section, you'll still have lochia for a long time. You'll want big pads to soak it all up. You may even want to strap a couple over your incision to provide an extra layer of cushion.

I don't have any advice on the condition your baby has but wish you both good health and all the best.
posted by otherwordlyglow at 8:47 AM on February 2, 2011

Start now to build up a list of folks to help out for the first week or two. Doing dishes/laundry, making dinner, helping with the baby, etc. Call your church or your book club or your family/friends and ask. Most people love to help, but don't want to intrude, so they wait for you to ask.
posted by CathyG at 8:55 AM on February 2, 2011

I had a surgical delivery, followed by an infection that sent me right back to the hospital. Given that 20 - 25% of births are surgical, I think it's unfortunate that birthing prep programs don't do anything to deal with that reality. Ask your doctor or nurse how to recognize complications.

Recovery from surgery means you need extra help. Fill the freezer and pantry with food for the 1st few weeks. Make sure you have toilet paper and other household supplies. Line up your friends and family. People will ask you if you need help. Say Yes! Ask people to sign up to be your helper for a specific day. You might need food cooked, a floor washed, and/or the baby held while you take a shower. Just knowing that somebody will be visiting after work to help out, even for an hour, is a huge help.

Good luck to you and your growing family.
posted by theora55 at 8:57 AM on February 2, 2011

My baby was just shy of 35 weeks and 4.5 pounds when he arrived. He did fantastic during his mandatory three-day NICU stay and was discharged with no complications. The NICU nurses did a car seat test for apnea but did not lay down any strict requirements on car seat ratings and size or fit. We got a handout that said it was our job to do that..I actually had difficulty finding a car seat rated under 5.5 pounds. We just used our regular infant carrier.

You can get preemie-sized diapers in regular stores and you definitely need them. Your baby will also be much smaller than most newborn-sized infant clothes are designed for. You can still use them, but the baby will be swimming in them and it might make swaddling harder. We got a few preemie-sized gifts and hand-me-downs and I really liked having something that fit him properly. Just don't worry about getting more than a day or two worth of small clothes - you do laundry frequently with a newborn and the baby will grow out of them in a few weeks.

For swaddling, which is a key part of baby sleep time around here, we found that some of the types of blankets we had were too big for him. The Miracle Blanket worked the best for us with a preemie, or just swaddling in a regular thin receiving blanket.

Temperature regulation is an issue - we turned our thermostat up permanently and also cover him in an additional blanket or two.

Your baby isn't technically a preemie, but due to his size may have a preemie-type issue of becoming fatigued when nursing. A breast pump is really nice to have in this case...I would nurse with a hard limit on the time and then top him off with previously-expressed breast milk in a bottle, then pump to build my milk supply. If your baby spends time in the NICU then pumping will be a must for you. My insurance paid for a hospital-grade rental for a month, but even once we got breastfeeding down at home it is nice to have one around.
posted by handful of rain at 9:02 AM on February 2, 2011

One of the most inconvenient things with a C-section is that you can't drive for quite a while afterwards. So if you're heavily car-dependent, you need to make plans.
posted by rhymer at 9:35 AM on February 2, 2011

I had a c-section with baby#1, who was 5lbs 10oz at 39 weeks, due to IUGR. Lots of good advice above about general c-section recovery, having food and help ready, car seats and preemie sized clothes and diapers. Note that preemie diapers are hard to find in B&M stores; Babies'R'Us was the only place that had them near me, so I ordered them online. Same goes for preemie clothes.

I could not breastfeed him for the first month or so, because his mouth was too small to latch on, so I had to pump and bottlefeed him. Whether this happens to you depends on the size of your baby at delivery, and the size of your nipples! But be prepared. A good double electric pump will be a necessity, you can rent (usually from hospitals or local mothering stores) or buy one. After a month he had grown enough that he was physically able to latch, and so we had to learn to breastfeed. This was tiring for everyone, and painful for me. I was determined (I am a VERY stubborn person), so I saw it out, it was not fun, but for me it was totally worth it in the end. It only took a couple of weeks I think. YMMV.

You WILL need a lactation consultant if this is the way things go, or if your baby ends up in the NICU and has to be bottlefed (too small, too weak etc). I'm assuming your baby's surgeries may complicate breastfeeding too. Find out if your delivery hospital has LCs on staff, what sort of support they offer after you are discharged, and line up recommendations and contact details for independent LCs if necessary. If your hospital has LCs on staff this is ideal, as they can help you (and be an advocate for breastfeeding/breastmilk) with doctors and nurses too. Sometimes it is easier for others if a baby is formula fed, so you may not get as much support as you need to breastfeed a post-surgical baby. Obviously that depends on the hospital and staff, but just knowing there is someone in the hospital who will be a voice of authority and on your side is a great help. I encountered mostly breastfeeding-positive staff at my hospital, so hopefully you will too.
posted by Joh at 9:35 AM on February 2, 2011

My little cousin was born with gastroschisis. He was in Children's Hospital Oakland for a few weeks after the birth to make sure all was well. There were no complications and he's now a 10-year-old daredevil who rides motorcycles and plays contact sports with the best of 'em. Good luck!
posted by wherever, whatever at 9:37 AM on February 2, 2011

I just noticed you are in the UK, so I guess I have no idea whether preemie supplies are harder or easier to find, what the deal is with LCs and breastpumps in hospitals there. Your health visitor will undoubtedly offer breastfeeding support, but I am goign to assume that if things are non-standard then you might need a certified (IBCLC) Lactation Consultant's help anyway. I assume though, that the UK is a bit more breastfeeding-positive than the US.
posted by Joh at 9:39 AM on February 2, 2011

I'm here to tell you that the odds are very good in your child's favor. I'm not familiar with your baby's condition, but I'll share my own story of having extremely tiny babies as another datapoint to show everything will most probably be just fine:

My twin girls were born at 31 weeks via C-section (one twin was almost out of amniotic fluid). They were tiny - one was 2 lbs 4 oz and the other was 3 lbs 11 oz. They were in the NICU for 5 weeks - many hospitals require babies to stay in the NICU until they would have been at least 36 weeks gestationally, so I'd check your hospital's policy so you can be prepared. They had pretty bad acid reflux, which is very common with preemies, but it was quickly diagnosed and treated with prevacid. Other than that, they were 100% healthy and perfect. They're now almost 5 (!) and you'd never know that they started out so tiny. I worried a lot in the hospital about the potential long-term damages, and quite simply, there have been none. They are smart and healthy as can be.

In terms of recovering from a C-section, it really isn't that bad. You'll be sore, and for the first few days/week you'll need help with things like lifting your baby (they say you shouldn't, but I'm sure you, like everyone else I've spoken to, will do it anyway) and particularly getting in and out of the bed. But really - it's not that bad. Take your painkillers, make slow movements, be gentle with yourself and ask for help, and you'll be totally fine. I've had 2 C-sections and had no issues with either.

Nursing was more challenging to me simply because my girls were so small. I had to pump until they were big enough to properly latch on. With my son, who was also born via C-section, nursing was a piece of cake and he latched right on. Not everyone has easy experiences with nursing, so don't beat yourself up if you can't get it right away or even at all. I'm as pro-breast milk as they come, but not at the expense of the mother's happiness or sanity. That said, I didn't find the C-section to be any impediment at all to nursing.

Please be as easy as you can about all this. There's a lot to take in, and emotions are high because we all want the very best for our babies - but try to find that calm place in yourself that knows that everything is going to be OK. Good luck and congrats!!!
posted by widdershins at 9:44 AM on February 2, 2011 [2 favorites]

Gah - I just read the part of your post that says you'll be having the section at 38 weeks, not now. So disregard all the preemie stuff! Sorry.
posted by widdershins at 9:47 AM on February 2, 2011

If you have a close friend or relative who can stay with you a few days after you come home, so the adults can triple-team the baby (or double-team, if you're a single mom) and someone can be preparing food for you, that's great.

In advance, we stocked up on toiletries & paper goods -- deodorant, shampoo, toilet paper, laundry detergent -- we aimed for at least six months of toiletry-free shopping -- so that we both didn't have to worry about it and to make a tiny bit more room in our budget for diapers, etc. Very convenient.

Scheduled C-sections are a different beast than emergency C-sections or those done after laboring for a while; the recovery is much easier from a scheduled one. So if people are telling you C-section stories, ignore any horror stories where they labored for 20 hours first ... that's a MUCH more difficult recovery than a scheduled C.

I got a couple of cheap dark-colored bath towels (at Target) that more or less matched my living room decor that I put underneath me when I sit down so I didn't have to worry about lochia leaking. Also used them on my bed. Another good buy is two ice packs big enough to go all the way across your stomach; the first week that provided me a lot of comfort and two means you can just keep swapping them.

I used an Arms Reach co-sleeper with my newborn, which meant I didn't have to get UP to breastfeed him in the night, and picking him up from there was easier on my sore ab muscles. That's a fairly significant outlay of money, though, and not the right solution for everyone. But I found it really simplified things for me after my C-section. That said, the first week I was home my mom stayed with us and the baby slept in with HER and she would bring him in to me to nurse and then change diapers and do burping and everything, so that we could SLEEP even if he fussed. This was good. I was able to concentrate just on the feeding part of breastfeeding AND on sleeping and resting to heal faster. But that requires having an awesome person willing to do that ... or hiring a post-partum doula or night nurse, I guess.

I really didn't find the recovery difficult, except I categorically refused to get in a car (so it didn't matter that I couldn't drive!) because the vibration was very uncomfortable on the way home from the hospital. I felt like after the initial incision closed up (by the time I left the hospital) I got to 75% or 80% in the time my vaginal birthing friends got to 90%, and it just took me a little longer to climb the rest of the way up that hill. It was the infant care that was difficult! (And that's difficult for everyone.)

Incidentally, my hospital provided far more lochia pads than I could possibly use AND a supply of incision-friendly disposable granny panties (that held the lochia pads in place AND could hold a pad over the incision, which is apparently a popular way of dealing with them once they're open to the air!) for C-section moms. Find out what's in your hospital's "new mom goodie bag" because they do often send you home with a TON of stuff for aftercare.
posted by Eyebrows McGee at 9:57 AM on February 2, 2011

Thanks so much for all your tips, stories and good wishes - much appreciated! She will be in the NICU for 1-2 weeks after the surgery (if all goes well, longer if there are complications) and has consistently been in the bottom 3%ile of size so far (I have scans every two weeks to check her growth and for infection, dilation of her bowel etc, and they will be weekly after 30 weeks), so the preemie info is relevant even if she is full term.

I'm thinking of not buying a car seat until she's ready to leave the hospital, as she might be more regular-sized by then - is this a stupid idea?
posted by goo at 10:30 AM on February 2, 2011

The bottom weight boundary for most standard (rear-facing infant) car seats in the U.S. is 5 lbs. (A few go down to 4 lbs.) Around me, parents of preemies and very small babies rent "car beds" from the hospital for infants too small for the car seat. None of my friends with preemies have bought special preemie car seats; again, that's probably a good discussion to have with the hospital or your pediatrician, find out what your options are.
posted by Eyebrows McGee at 10:35 AM on February 2, 2011

And thanks, 2003girl and wherever, whatever - I know the prognosis is usually very good for gastroschisis but it's still very reassuring to hear positive stories!
posted by goo at 10:39 AM on February 2, 2011

Thanks, Eyebrows McGee, I will.
posted by goo at 10:51 AM on February 2, 2011

Nthing pretty much everything already mentioned about people to help, food, toiletries, etc. I would also suggest, if you live in a house with stairs, to try to set up everything you'll need on one level. After my c-section (emergency, so it sounds like you'll probably have an easier time) I couldn't really handle stairs for several days after coming home, but the socks/book/lotion I wanted always seemed to be on a different floor than I was, and it got really irritating for everyone involved.
Oh, and stool softeners.
posted by phisbe at 11:05 AM on February 2, 2011

My advice is to buy everything before the birth. Life is a whirlwind once the baby's born, whether the baby is in the NICU or not. Plus, if you're recovering from a C-section, the last thing you'll probably want to do is go out shopping for a seat.
posted by puritycontrol at 12:05 PM on February 2, 2011

To follow up - gastroschisis babies are usually born a few weeks early as the risk of infection (of the baby's bowel and intestines) is high. At 35 weeks my OB told me they wanted to induce the next week - I can only surmise it was the end of the month and their c-section stats were too high already. So I endured a 44 hour induced labour before having an 'emergency' section due to failure to progress and my bp dropping to 50/25. Anyway, beautiful Stella Grace was born at 1.7kg (3.7lb) at 36 weeks. She spent 34 days in the NICU (I have no idea where I got the 1-2 weeks from, six weeks is apparently normal for an uncomplicated gastroschisis repair) where I roomed in with her for the last week. Her gastroschisis surgery was totally without complication (one surgery, no silo) and I could hold her the next day.

For the purposes of this question though - I was fine after the c-section re: stairs etc. I think I had to be as once I was released from the hospital I had to get there every day to see her, which involved stairs. I took the drugs they prescribed immediately afterwards (co-dydramol and diclofenac) but didn't need any refills. I bought a belly bandit and wore it once my stitches were removed - I couldn't breathe with it for the first few days and then I only wore it for another couple of weeks before it was too big. I think it helped though.

Breastfeeding a tiny baby - well, she was in the NICU and intravenously- and NGT-fed for the first five weeks so I pumped. That was fine, the issues only started after I got her home. Tiny babies used to being artificially fed get very, very tired when they have to suck for themselves. She latched on fine, but I was feeding for four or five hours at a time sometimes (breast or bottle, didn't matter), with her asleep for most of it. This was extremely draining for both of us. She gained weight very slowly, until she had a two day bout of diarrhoea and lost weight after which we ended up in hospital again and she was prescribed high calorie formula (infatrini). Since she has been on the formula + breastfeeding she is coming along in leaps and bounds - she is now 16 weeks and finally proper newborn size (3.1kg, 6.8lb), and breastfeeds very well.

Other tiny baby issues - clothes haven't been a problem, for those in the UK Marks and Spencer's 'tiny baby' and Mothercare's 'early baby' size clothes are great - they were too big initially but are finally starting to be too small now at 16 weeks. The one issue I have found is toys that are developmentally appropriate but small enough for her tiny hands. She is very alert and with it and doesn't display any developmental delay (in fact the opposite, she was rolling over at seven weeks) and it's hard to find toys that fit. Baby gyms should have adjustable straps for the overhead toys and rattles need to be small. Reusable nappies have also been an issue - actually I haven't been able to find any to fit. I have them all ready for when she's 4kg, but until then it's sposies.

Thanks for all your help! I've marked the especially useful answers as best, but you all gave me lots to think about.
posted by goo at 5:39 PM on July 22, 2011

Thanks so much for taking the time to update. I'm thrilled to hear that everyone is doing well. Sounds like nursing is even getting on track. Hurray!!
posted by otherwordlyglow at 9:05 PM on July 23, 2011