Grandparenting in the NICU

A year ago, my husband and I became first-time grandparents to identical twin baby girls born several weeks early. Their weight, together, was just over 8 pounds. We met them when they were a few days old, in the Newborn Intensive Care Unit, also known as the NICU.

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A little over 35 years ago, I was a newly graduated physical therapist. Rarely, I evaluated infants in the NICU, a small room literally lined and filled with isolettes (a kind of enclosed, plastic bed-box providing controlled temperature, humidity, and oxygen levels). The lights were fluorescent and very bright. It was noisy, with alarms and multiple conversations between medical professionals who packed themselves in between the babies and their rarely-seen parents.

I will never forget one hapless young mother who wedged herself into a corner to use a breast pump: no curtain, no privacy — and probably, in my now-experienced position as a two-time breastfeeding mom, not much milk, either.

Fast forward to 2017: You can imagine my surprise when we meet our granddaughters in the modern-day evolution of neonatal intensive care. There is an entire wing of the hospital devoted to it, complete with several “suites,” each a room probably twice as large as the NICU of my memory.

Lights and noise are low. In their own, curtained-off section of one suite, my daughter and her husband sit in two easy chairs between the girls’ isolettes. The isolettes are empty. The babies lay, skin to skin, on their parents’ chests.

The babies are doing well, the nurses tell us. They are here to gain weight and learn to suck. My daughter breastfeeds them at every opportunity and faithfully pumps milk for the nurses to bottle feed and/or gavage (nasal-gastric tube) feed them. On occasion, we are allowed to bottle feed our granddaughters. We must position each baby on her side, to prevent aspiration. The nurses show us exactly how and radiate nothing but encouragement.

Everything is tiny: the bottles, the noises the girls make as they eat, the amount they consume before they rest, exhausted. It saddens me that when you bottle feed them on their sides, you can’t look at them as they eat. “Don’t make direct eye contact,” the nurses tell us. No petting or stroking either. These are not stimuli the babies would have had were they still inside; they are easily sensorily overwhelmed. The nurses take the babies from us and gavage the rest of the feedings.

They place the babies back in their isolettes. They swaddle them aggressively and position a heavy, specially-shaped and -made sandbag over each infant’s chest. “The babies are used to pressure all around them,” the nurses tell us. Then they dim the lights and cover each baby bed with what looks like a homemade quilt, just like a bird in a cage.

What you won’t be told is when the babies will go home.

No nurse or physician wants to make a promise she or he cannot keep. Everyone observes the increasing ratio of bottle to gavage feedings, the weight gain, all the signs of progress: no longer needing oxygen through nasal cannulae, removal of the heart and respiration rate monitors, being moved out of an enclosed isolette into one more like a very small crib.

Each time, each baby seems closer to coming home. But then one has a bad night of feeding, taking very little by mouth, or worse, going through the gargantuan effort of sucking a bottle near-to-dry only to vomit the entire feeding seconds later. This is a problem for the second-born baby in particular, all the more worrisome because she is still so small.

It is probably a function of seniority that the day shift nurses are generally older and a bit more set in their ways than evening and night shift nurses. Well into over a month of living in the hospital (literally or practically), my daughter and her husband show few signs of wear except for maxing out on the baby care advice from these headstrong, highly skilled women, who often insist on holding/changing/feeding/burping/bathing/performing any other micro-manageable behavior in some irrefutable way.

It’s not that the kids aren’t grateful; they are, of course. When they are instructed in how to bathe the babies, it is just as the nurse predicts: the girls’ faces transform in what truly looks like pleasure as their scalps are scrubbed with a toothbrush and rinse water washes over their heads. My daughter and her husband learn and execute this task, as all the others, like pros. Nonetheless, they have slyly drifted toward spending more evening time in the NICU, in the company of equally skilled, but less opinionated, younger nurses.

One day we learn that only one baby of another set of twins, who have resided next to our grandbabies these past few weeks, has gone home. We are confused. Only one went home? It's hard, is the answer we get.

Hard? Our older grandchild, bigger from the start, seems to do everything first. Why can’t they keep her in the hospital until her sister is ready to go home? How will my daughter manage to breastfeed one child at home and one in the NICU? How will she feel about leaving a baby behind?

Being a grandma isn’t only about the grandbabies, I’m learning. It’s also about watching, amazed and fiercely protective, as my own first-born daughter makes her levelheaded and easygoing way — even under these stressful circumstances — toward motherhood.

It seems the day may be getting closer. One afternoon, both girls are rushed away for a hearing test. They pass. Then the kids are asked to bring in a car seat for “the dreaded car seat test,” as we come to think of it. Number one grandbaby is made to sit in a car seat for a ridiculous amount of time, strapped in tighter than Spanx, while her vital signs are monitored. She fails. She won’t go home until she passes. If she can’t pass, how will her sister, who is still at least a pound smaller?

At this point, my daughter and her husband are ready to put both kids in day packs and walk them home. Which may, in fact, be the best evidence of how far everyone has come.

The day arrives. The two separate days, that is, when the girls come home. They are identical twins (they shared a single placenta) but there is little about them that is identical, from their physical appearance to their emerging personalities to when they are ready for discharge. But come home they do, and soon enough, the few chaotic days of running back and forth from home to feed one or another are over.

This much is clear: these two tough and beautiful little girls are not my babies. They are my grandbabies. All of the fun and none of the worry, they say. What they don’t say: the worry, and pride, remains, for the child who is your own.