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Tuesday, April 5, 2011

The Smallest of Small: Cloth Diapering a Preemie

The unexpected birth of our third daughter at 25 weeks and 4 days gestation threw me into a cloth diaper frenzy. I was certain that I had three and a half more months to figure out the ins and outs of cloth diapering, what products to use, where to order from, and how to do it. The last thing I expected was to be sitting in my hospital room without a full term baby and researching cloth diapering to distract me from the stress, worry, and fear that consumed my mind as my daughter fought for her life in the Neonatal Intensive Care Unit at a different hospital 40 minutes away. After all, we were supposed to be visiting the area for 3 weeks, not 3 months, I was supposed to have the baby with my husband by my side in Colorado, not alone in Connecticut, and I was supposed to have more time to get my cloth diapering act together. Amid all the chaos that ensued with my daughter being admitted to the hospital for the following 14 weeks, and my other two daughters and I taking up residence with my parents for the duration of that event, figuring out the details of cloth diapering seemed like a realistic and manageable goal to achieve in midst of the storm we found ourselves in.

Body by preemie.
Even though I knew that 24 weeks gestation was likely the minimum gestation that I needed to reach in my pregnancy in order to give my daughter a chance of survival, I never considered the physical implications of a baby that age. Sure I saw the seemingly fully formed body parts of my daughter at the 20 week ultrasound just a few weeks earlier; but the fact that I never expected my daughter to be born 5 weeks after that ultrasound caused a lapse in my thinking perhaps. Despite the fact that my daughter was born at 25 weeks and 4 days, weighing two pounds, and reaching 13 inches in length (almost the same size as a Subway sandwich), she looked like a very tiny newborn. Apart from the hairy body and transparent skin, she was a complete newborn. She had fully functioning female parts, and the tiniest butt I have ever seen. Incredibly, those little parts tried their best to work just like a full term babies’ parts.

Potting preemie style.
As cute as that microscopic butt was, the internal pipes were not mature (by full term newborn standards) and therefore were met with some challenges. It took several days for my daughter to have her first poop. Interestingly enough, the first poop from a preemie was the same sticky, black meconium of a full term newborn. She continued to poop just like a full term baby (only proportionate to her size) after that, but it was much more difficult. Even though she was on a full breast milk diet through her feeding tube, her intestines were being asked to digest food 15 weeks sooner than they should have been. As a result, she needed frequent assistance with achieving those poops. Suffice to say, the preemie poops were a highly anticipated and much celebrated accomplishment every time they occurred in the NICU.

The diapers for those preemie poops had to be specially made, so even the smallest of small cloth diapers would not fit a micro-preemie. Besides the fact, the nurses were responsible for weighing each and every diaper that had been worn to be sure the babies were peeing and pooping adequately. To ensure accuracy and continuity in the weighing of the diaper, as the measurements were taken seriously, the hospital had to use the same brand diaper for every baby every day so disposables were it.

Knowing the size factor and the hospital’s policy on diapers, I decided to order the smallest fitted diapers and covers I could find and wait anxiously for the day that I could bring my baby home to those tiny little fitted diapers. I must confess there were a few times when I was left unattended to change her diaper and I managed to sneak a cloth on her for a few minutes just to see what it would look like. These fleeting opportunities made me even more anxious to get her home and into those super cute fitteds!

Size what?
Given the exceptionally small stature of my preemie, finding the right fit of cloth diaper for her was important. Even though preemie bodies are miniature versions of a full term newborn, typical preemies don a “preemie belly”. In the hospital, the “preemie belly” develops often as a result of the extra oxygen support that the babies require. Although the medical staff tries to reduce the unnecessary over consumption of air, certain breathing supports such as CPAP (Continuous Positive Air Pressure) creates extra air which ends up passing into the belly where it can collect and create a potbelly or “preemie belly”.

As a result of this “preemie belly”, even though my daughter was barely five pounds I could barely fit the size 0 Kissaluv’s fitted diaper (which is sized for babies 5 to 15 pounds) around her waist. Whereas a typical five pound newborn would probably have the diaper snapped down in the middle to protect the umbilical stump, and on the tightest setting across the front, I had to unsnap the umbilical fold and use the snaps at the furthest setting out around her waist to make it fit comfortably across her belly.

Given the fact that my five pound baby was hardly fitting into the size 0 diapers, it was no surprise that at nine pounds she needed to graduate to the next size up. About three quarters of the way through her stay in the hospital her belly reached its largest disproportionate girth, but she continues to have that ”preemie belly” even six months post delivery. We used the Kissaluv’s fitted diapers for a while, but discovered that they were no match for her oversized belly and little skinny little legs because the size of the diaper she needed to accommodate her belly became too big for her little body. Instead we switched to the Thirsties Duo Fab Fitted diaper which provides more range in sizing and a better fit for her type of body. She is happily wearing the Thirsties Duo Fab Fitted diapers and is in line to inherit her big sister’s Fab Fitteds before long.

I am not certain as to how much longer I can expect this “preemie belly” to last, but six months into our cloth diaper adventure we have found our niche. Our daughter spent 14 weeks in the hospital, and came home to us one week before he due date weighing 5 pounds 3 ounces. She is now 6 months old, 9 pounds 7 ounces, and one of the happiest babies I could ever ask for considering all she went through to get here. Digestion and elimination continues to be a challenge for my preemie, but considering how far she has come, we are thrilled with her progress and adore the sight of her wearing cloth diapers.

By Guest Blogger Sarah


Emily said...

What a great post, thank you for sharing your story. I am mom to a preemie too and I couldn't wait to get him home and put some cloth diapers on him. I used to hold his cloth diapers at home and weep over them. He will be two in a few weeks and has more cloth diapers than you can imagine.

Have you seen the new Happy Heiny micro preemie diapers? They were designed especially for hospital use, all weighing exactly the same. If I ever have a preemie again I will be Making (I mean asking) the hospital to use them. Here is a link to some info on them:

Beccalynn said...

She's so beautiful and I loved reading your story!

ummcarter said...

so what folds work well? My mirco premmie son could very well be coming home in a couple of weeks. He was 1 lb 7 oz, 11.5 inches at birth (27+) weeks. He is now 4 lbs 5.5 oz. He measured 15.25 inches last Monday.

Stacey Gardner said...

I am so glad I came across this post. I am 23 weeks along and found out that there is a possibility they may have to take my little girl as early as 25 weeks. That idea itself is extremely scary but after calming out my nerves I wondered if it was even possible to cloth diaper such a little one. Thank you for all of the info...I feel much better about what might be coming down the road. :)

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