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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
Sleep after the NICU is complicated, not just for babies, but for parents too. Premies have different developmental timelines, different sensory needs, and often different medical journeys that shape how and when they sleep. Add in parental trauma, nighttime anxiety, and navigating life after the NICU, and sleep can feel like one of the hardest parts of bringing your baby home. My guest today understands this from both sides, personally and professionally. Jamie Ortiz is a NICU mom, a sleep consultant of over four years, and founder of Little Ones Sleep Society.
As both a NICU and loss mom herself, brings a depth of empathy to sleep work that you can't learn from any certification. Whether you're a NICU parent craving rest, a doula supporting families after discharge, or a provider wanting language that's grounded, compassionate, and realistic, this episode is for you.
Mary Farrelly (01:23)
Hi everybody and welcome back to this week's episode of the NICU Translated Podcast. I am so excited to have Jamie here today. Welcome Jamie.
Jamie (01:31)
Thank you so much, I'm so excited to be here.
Mary Farrelly (01:34)
So today's topic is one that comes up all the time, both in the NICU as a bedside nurse and then helping families with that transition to home, which is all about sleep. So let's kind of rewind from the beginning and get to know a little bit about you, your NICU experience and maybe what brought you to sleep consulting in the first place.
Jamie (01:54)
So my NICU experience started with our second born. Our first born, my water broke at 21 weeks, I think, 20 weeks, right before the lungs are developed. So we could not keep him any longer and so he passed away.
they were preparing me before we knew that my body was just not gonna carry him to term.
We knew that it was going to be a NICU life and it was going to be a really long road because of everything that had happened. So when I got pregnant with our second, he, it started all over again, very high risk. I needed a circlage. I need a progesterone. I mean, you name it, I needed it. And I still, my water broke at seven months. So in the hospital, tried to keep him as long as we could, but he had other plans. And so
They were prepared because of my previous history. So they gave me two steroid shots and then it was time to give birth and push him out. And he didn't need any support breathing, but he was in the NICU for about two and a half weeks. ⁓ My husband was deployed when I was giving birth and came to see him, I think maybe like three, four days after he had already been in the NICU and then he had to leave again. And I was still in the NICU during that time. And it was really stressful. I relied on the nurses.
a lot, a lot, a lot, lot. That's when I started to realize during all my pregnancies how important nurses are. They're always important, but when you're hospitalized for a month and a half and it's like, they're the ones you're seeing every day. They're the ones who really know your history. mean, there was people, doctors who were getting information wrong on me. because they're seeing other patients and things and the nurses are the ones during their entire shift coming in, they would have lunch with me because I was just there for monitoring. And so, you you
these relationships and you start to see, man, like these nurses are the ones that we depend on 100%. I mean, I could not leave my son without crying. it was just a, was a, it was a hot mess. ⁓ And then when you're about to get discharged, you know this, they give you so much information. ⁓ My best friend was there with me and we were both looking at each other like, I don't know anything. I don't remember anything that they just said.
I'm just gonna call back later because I would call the NICU and thank God for the nurses are so understanding of like how paranoid and just information overload, right? And so we went home. I had no idea what sleep looked like for preemie babies. I was so angry and so frustrated. My husband was still deployed and I naturally, my son was waking up at night, right? Like we all know this, but there was so much that I didn't know. Why weren't his naps connecting? What am I doing wrong? ⁓
Mary Farrelly (04:19)
you
Jamie (04:40)
And the more I started to read, the more I knew that I wanted to see him when he was old enough, but there was no information on preemie babies. Not a thing So I was treating him like a full term baby, not knowing anything. And this was when he was eight months, but adjusted, he would have been about six months or so, right?
⁓ So I messed up. I didn't know what I was doing. And then I decided with my daughter, who was born at eight months, so not NICU for her, but still she was born also, you know, a month early. ⁓ I said, I'm gonna do things differently. I got certified with sleep Consulting because I'm like, well, all these other moms are stressed out. I'm not the only one. I know this for a fact, but I still could not get information on preemie babies. Okay? Like I had no idea still what I was doing.
And then I connected with a neonatologist, a concierge pediatrician who was a neonatologist back home. he's like, most of the babies that I work with are preemie babies. And I said, talk to me about preemie sleep. I don't understand it. And so through him, we came up with like a whole guide ⁓ for preemie families. This is what sleep looks like. All of these things that when I looked at it made so much more sense when I was working with my son. And I'm like, this is why.
This is like, and then of course you feel bad. I mean, he's fine, but still you feel bad. And so now that's a part of what I do. just, love preemie babies.
Mary Farrelly (06:08)
That is such, isn't it fascinating listening to people's stories and be like, all these different things happened and then you had no idea in the moment what any of it meant. And it's all, it was so intense and so hard. And now you're on the other side of it and all these pieces came together and now you're able to pay it forward and give so much meaning to your own story and your own work and be able to help those that are in the trenches and living it and be like, you don't have to go through the same thing that I went through.
Jamie (06:17)
Yeah.
Right.
Mary Farrelly (06:36)
You can have
a better experience. Let me help you get there. So that's amazing that you're able to find that resource because I totally agree to the information even that we share in the NICU about preemie sleep is very limited. And it really, I feel like kind of sets up the families for additional stress that maybe doesn't need to be there because one of my key tenants about all the work that I do is that a lot of trauma is linked to
Jamie (06:39)
Yes. Yeah.
Right?
Mary Farrelly (07:05)
not having the ability to make informed decisions and feeling powerless and overwhelmed because you simply do not have the knowledge or education to do that. So filling the gaps in knowledge and education is what's gonna allow families and babies to truly thrive. So let's kind of dig into the nitty gritty a little bit of this topic. What is the like number one thing that is different from preemie sleep versus like a well termed baby?
Jamie (07:14)
Mm-hmm.
Mary Farrelly (07:34)
sleep because either way newborns not sleeping like an adult. It's very different no matter what. But what is it that's unique about preemie sleep that you want families and care providers to know?
Jamie (07:37)
All right.
It's interesting because it's not a catch-22, but they need extra sleep. They're extra tired. Their bodies still didn't have time to form in the womb, so it's got to catch up on stuff and that's exhausting. So they need extra sleep. But at the same time, as they get a little bit older, they don't know, like their body is not where it should be biologically again, because of an adjusted age. So a lot of parents, when they go to the pediatrician, they'll say, okay, well, you know, what's their
They go by adjusted age when it comes to feeding, some things like that, but there's not a lot of knowledge from other professionals when it comes to sleep. And so they don't necessarily tell these parents, well, the reason why you're going through this with sleep, the reason why this is because they're not eight months, technically. If we're doing everything by adjusted age, okay, well then that means sleep is too. while your baby at eight months is physically eight months old, okay, that should be about two naps a day. Well, a preemie baby.
in most cases, well, going by adjusted age, they might still need three or four naps, depending on how preterm they were, medical conditions and things like that. So they need more sleep when they're newborns. And when they come out of a newborn, that adjusted age can, some babies will be all right. And some babies really have to go by what their adjusted age is versus ⁓ a full term baby.
Mary Farrelly (09:08)
Right. Especially if you're bringing home a baby from the NICU that is still premature, like is still not even at their due date at that point, which is fairly common, especially for like those middle preterm events, like 28 to 32 weeks. Sometimes they're going home at 35 weeks, 36 weeks, and their bodies are still, as you said, they're still developing. Like they are still doing a lot of work. They're healing. Their bodies have already turned on and have been told to digest.
to breathe and do all these things that it wasn't supposed to be doing. So just makes more sense that they're going to have different sleep needs, similar to their nutrition. They're going to need more calories potentially to kind of catch up. They're going to need more calories of sleep calories. I had to just pull that out of my booty ⁓ to be able to, ⁓ please do, sleep calories.
Jamie (09:42)
Right.
Right.
Mm-hmm.
I like that, calories, exactly. Yes. I'm gonna coin it and give you credit, because I like the word, yeah, Sleep
calories is the way, yeah. It's interesting, and I didn't know, and when I found out, it made more sense with my son, just the act of caressing.
Mary Farrelly (10:08)
Yeah, great. ⁓
Mm-hmm.
Jamie (10:18)
A lot
of preemie babies, don't respond well to that. Like their nerves, it overstimulates them. Their nerve endings, their nerves just haven't done what it's supposed to do. for, while ⁓ a full term baby, if you caress their cheek or something, they're just kind of like soothing. A lot of NICU babies, like kind of like, not freaks them out, but like it overstimulates them. Or so instead of doing that, then it's pressure, put deep pressure on them versus, you know, ⁓ the caress so that you're not overstimulating. Like all these things that I'm like, my gosh, my son.
Mary Farrelly (10:33)
Mm-hmm.
Jamie (10:46)
hated that and I had no idea because nobody around me had had a premature child. We had no idea, you know, and it's like when they're starting to fall asleep, I would do that and be like, Whoa, what's going on? And I have to start from scratch again. And just little things like that. A lot of people don't, they don't know, you know.
Mary Farrelly (10:59)
Mm-hmm.
Mm-hmm. Yeah, their whole
nervous system is completely different, right? Like when you're a preemie and you're in developing in utero, your body's not being touched. It is getting firm pressure, When you push out and the baby kicks you in your bladder, that feedback immediately from your body, from the uterus to be like, okay, no, come back to the space line. But there's nothing.
Jamie (11:22)
Yeah.
Mary Farrelly (11:29)
in there that has that light touch, that sensitive touch. So their little brains are just like, whoa, what's this one? I don't know anything about this. So what, we kind of touched on this a little bit, but in terms of adjusted age, is that kind of a hard and fast rule? Like if someone is taking their baby home and now they're, say they're four, they're two months old and they're corrected to term.
Jamie (11:32)
Right. Yeah.
Mm.
Yeah.
Mm-hmm.
Mary Farrelly (12:00)
Is
it expected that they're going to have that same exact timeline to sleep progression and development? And if yes, how long should they be expecting that? Does this continue their whole baby-dom versus into toddler years? What can parents expect when it comes to adjusted age and sleep?
Jamie (12:16)
Thank
So the first thing is when we're talking about as like a sleep consultant, I will either work with families on sleep shaping, which is laying foundations or sleep training. And you don't want to sleep train a child until they're at least four and a half, five months of age for biological reasons. On top of that, if a child is preemie, like for my son, he got the go ahead on everything. I think that six or eight months, like he, the doctor was like no longer adjusted like
It was creepy. like, this was the weirdest. I think they got my due date wrong. Like this was the weirdest preemie baby ever. Right? So the first thing when I do find out, is your child a premature baby? What is their adjusted age? Speak to the pediatrician first. Right? And then, okay, the pediatrician is like, no, they're all clear. Treat as a, and this can happen as a full term baby. And this can happen at eight months. I've had toddlers at two years. The pediatrician is finally like, you know, okay.
they're good to go, it really just depends on their history, on their health, and it's not just an adjusted thing, it's based on their health, where are they at as far as ⁓ milestones and things like that. So it varies, but the first thing is talk to the pediatrician first, and then if they are, ⁓ if the doctor gives you okay for sleep training, then at that point,
we would go by an adjusted age. Okay, this is where what sleep looks like. And then some babies thrive and we're like, okay, well then you know what, this might be their adjusted age, but mentally they might be ready. So as we're working together, we could see, maybe your baby technically based on adjusted age needs three naps, but we're seeing after a while, nothing, it's just not, it's not getting better. Let's try and treat a little bit more as their natural age, like what would be their age and then they do great.
Mary Farrelly (14:12)
Mm-hmm.
Jamie (14:12)
So I see
everything. Babies are fascinating. And I always tell parents, they're gonna surprise you. Like trust the process, you know, be patient. They will always surprise you. And there's times where I'm like, my gosh, holy moly. They surprised me and I've been doing this for over four years. And I'm like, look at this baby girl. I never underestimate a preemie. With my own experience, I'm like, you guys, they are the top dog. Yes, they're top dogs, these baby babies.
Mary Farrelly (14:15)
they are.
Mm-hmm.
Nope.
They're built differently. They have the same things
and they don't mess around.
Jamie (14:42)
Yeah, yeah. I mean, listen, they were already, they were tired of being in the womb already. They're like, I'm coming in early. If that's not a sign of a take charge type of attitude. And the preemies that I know around me, like adults that were born prematurely, they all have the same personality type go-getters. know, like they're just, they're built differently, I think. And they just take it with them to adulthood.
Mary Farrelly (15:03)
that I think that sometimes, especially I mean, I did not have NICU babies and I was a NICU nurse for many, many years before I had my daughter, but I feel like I was looking for recipes, protocols, plans of how to, if you do this, then this will happen. And I remember having this moment of like, surrender reckoning and be like, these babies are people, they are people, which means they are different. They have personalities, they have preferences, and they come out wired with that.
For better or for worse, there's temperament is involved with that and need to adjust at age and experiences and medical needs. It's not a simple, straightforward plug and play. It's art really, right? You're really getting to know this new baby in your life as a person. once you kind of are, and that takes time, just like building, know, making a new friend as an adult is hard. It takes time.
Jamie (15:35)
Yes.
Right?
Thank you.
right.
Mary Farrelly (15:59)
you have to
Jamie (15:59)
Yeah.
Mary Farrelly (16:00)
build a relationship and get to know everybody. I feel like once having that lens shifts the expectations, which makes it harder to not have expectations met, right? Like kind of just surrender a little bit and are curious about what's going to happen versus like if this XYZ sleeve doesn't happen by this day at this time, then I did something wrong or there's something wrong with my baby. It kind of settles out a little bit from there too.
Jamie (16:25)
Right. Yeah.
Mary Farrelly (16:27)
So let's talk a little bit specifically about that early transition from the NICU to home. Because in the NICU, there are very, very typically strict schedules around care times, right? PBs are fed usually every three hours and they'll be in a very like time oriented, like we eat at eight, 11, two and five. And one thing is we're talking about this that I didn't have as epiphany until much later as a NICU nurse.
Jamie (16:33)
Mm-hmm.
Mary Farrelly (16:55)
is that those specific times are for the nurses because we have multiple babies that we're caring for. So the interval, right? Babies are gonna naturally need to eat roughly every three hours, but the strictness of like, are eating at 8.01 and 11.01 and if you eat at 11.05, you're wrong. then eating down to the milliliter and tracking every single half of a milliliter and spit up and everything.
Jamie (17:12)
Thank
I remember that!
Yes.
Mary Farrelly (17:23)
That's what families are typically seeing as what is quote normal. Like that is the routine that their baby has typically until the minute of discharge. So how we help families with that early transition from rigid NICU schedule to home and then how does kind of sleep interplay with that.
Jamie (17:32)
Right.
I was whatever the NICU was doing. I did it to a teen or my life would fall apart I'm like, this is how he is surviving This is what we're do and I'm not veering from this no matter what to this day I'm still like that and my son is as well. He's very schedule driven ⁓ So it's interesting because especially depending on how long right sometimes these babies will be in early like my son was in there for two and a half weeks he was kind of
Mary Farrelly (17:49)
Mm-hmm.
Mm-hmm. Mm-hmm.
Okay.
Jamie (18:12)
in my eyes, a special case, because a lot of other NICU babies are there much longer, right? They're not, didn't, mom didn't get a steroid shot to help with the lungs and so where they didn't need help breathing and things like that, right? So we were, ⁓ it was a little bit easier in that sense. So usually for babies who are in the NICU a little bit longer, well, now their body is just naturally falling into a natural rhythm. And so we go based off of that until...
again, things kind of start to wean a little bit. The doctor, pediatrician will now say, okay, well now we don't have to fortify their milk. Let's get their, as far as weight gain. Okay, so then now that sometimes can shift ⁓ a feeding schedule because now they're not getting as many calories. So maybe it could mean maybe they're ready for longer stretches. It could mean maybe they're not getting as many. So maybe they might fall back a little bit and need to eat a few minutes sooner, 30 minutes sooner, things like that. So when we work with families, what I like to do is I ask families to track
Mary Farrelly (18:51)
Mm-hmm.
Jamie (19:06)
feeding and sleep for three days consecutively. Track, track, track, track, track. My job is to look at everything and say, this is where baby's naturally falling and to come up with a schedule that is conducive to that until the doctor again gives the all clear of, well, go on with your life and treat baby as a full term baby or baby has reached all the milestones, things like that. And if that's the case, then we go in and...
I'm still tracking, there's still babies, I still have to eat. But then something where it's not, it could stay rigid, some moms really like a schedule to make things predictable and it's what they know. Some like a little bit more flexibility so they can just go out and do whatever they wanna do. And then that's my job is just kind of what does baby need and what does a family dynamic look like and then create something that fits what they're needing.
Mary Farrelly (19:46)
Mm-hmm.
I love that idea of just tracking for three days especially because oftentimes what I see especially working with families post discharge is that people are responding to one situation often, like one bad feed, one bad night, and it's like, okay, well this happened, we need to fix it immediately. And I'm like, no, we can look at the trends, like what's the overall trend about what's happening? Like I'm allowed to have one as an adult.
Jamie (19:59)
Yeah.
Right. Yes.
Mary Farrelly (20:23)
of one bad night of sleep. It doesn't mean I'm going to like go and buy a new mattress tomorrow, right? Like we want to do that as parents. We want to make sure our babies are comfortable and getting what they need. And we want our own sleep and all those things too. But I love just taking a step back and taking an inventory of what is actually going on. And sometimes, especially with pre-me's with sleep, also tracking feeds and other symptoms, especially around reflux and things like that, you can start to see real patterns and clues.
Jamie (20:28)
Right.
Right.
Mary Farrelly (20:52)
that you wouldn't necessarily be able to see when you're like in the weeds covered in spit. ⁓
Jamie (20:58)
Right, I know. When you see it on paper, and
I think most parents are tracking anyway when they, there's nothing scarier than taking your baby home from a NICU where they have safety and somebody watching around the clock. My son was not sent with any monitors, so I knew that they were making sure he was alive and breathing, even when they would put him on his stomach and I was like freaking out. And they were like, he's on the monitors, like we're good, you know. And you take them home and you're like.
I have to keep them alive and I'm not sitting home with monitors, right? Some babies are, some babies aren't and it's like, you're just got all of these things. So if you just take a step back, you start writing everything down. I'm a pen and paper girl, so I bought a journal and I track. I I still have that journal to this day, Fed, milliliters. I mean, you know, and then I look back on it now and I'm like, my gosh, like how did we get through that? That was really rough. And you know.
Mary Farrelly (21:37)
Yeah.
when it is.
Jamie (21:49)
but you start to see that there is naturally a pattern. If you do anything long enough, there's going to be a pattern, right? And so these babies come home already having been on a pattern that works for them, and then we kind of go with that.
Mary Farrelly (21:55)
Mm-hmm.
Yep. And another thing that I feel like sometimes comes up, especially with babies and preemies too, is that like, okay, I figured it out for like this week. Like we have this rhythm and then all of a sudden the baby grows and develops and changes. And then you have to like go right back to square one, start tracking again and knowing that babies are rapidly, rapidly changing for the first thousand days of their life. They're literally growing an entire brain and an entire body and they're quadrupling in size. It's insane.
Jamie (22:11)
Yeah.
Yeah.
Yeah.
Mary Farrelly (22:31)
So
there's a level of grace that we have to have with everybody too. Like it is going to work for now. It might work for a little bit of time, but we know that it's always evolving and changing too. ⁓ And planning for the unexpected as more like expecting the unexpected and knowing that you can't for everything.
Jamie (22:40)
Yeah.
Mm-hmm. Yes, it is.
Right, yeah. Or you have
the night that goes really well and you have to replicate everything. You're like, it's gonna fall apart. And it's like you did everything and it's still not what it was before because it's ever changing. like you said, mean, I'm very realistic with the families that I work with. Listen, they're not robots. We wake up and we sometimes struggle to go back to sleep or we can't settle and we need all these little things to make us feel like, I'm ready to go to sleep now. It's the same with them as well, you know?
Mary Farrelly (22:56)
Yeah. Right.
Right, they're just little people doing the same thing. Sometimes I need to get out and go to the bathroom and listen to some spa music and then I can go back to sleep too.
Jamie (23:20)
Yes! Fascinating little people!
You know
exactly you got to get the head right so your body can be in a relaxed state and receive the sleep.
Mary Farrelly (24:29)
Another thing that comes up, especially around NICU babies, preemies or term infants too, is ⁓ the medical complexities that a lot of babies are coming home with. Sometimes they have feeding tubes, oxygen, other things like that. And then often one of the biggest things that goes hand in hand with a post discharge from the NICU is typically some feeding issues, especially around reflux, infant dyskisia, just tummy troubles in general.
Jamie (24:40)
Yeah.
Mary Farrelly (24:56)
So how do these different factors interplay with sleep expectations and what is realistic for medically complex babies around sleep?
Jamie (25:06)
I usually would tell families do sleep shaping and because that is very, ⁓ it's not fast paced. is at the child, the child is leading everything. It is set to what that child needs. It is something where you're just literally laying foundations and that's as simple as routine, room environment and how baby gets to sleep. If they have reflux, of course you're not laying baby down right away. You're gonna.
you know, keep your baby upright for X amount of time. Sometimes they have to be given medications, all these little things. And even then sometimes I'm like, well, what medication are they on? Some medications have side effects. Could that be a reason why we're seeing maybe something with sleep? We're not taking away medication, of course, like never, that's a pediatrician's job, but we are saying, okay, well, if this is a medication they're on, if there is a possible side effect, okay, then this is how we kind of have to rewire what sleep looks like. It is a little bit.
Mary Farrelly (25:39)
Thank
Jamie (25:58)
harder as far as getting those longer stretches because they a lot some kids still have to be woken up for a medication. Some kids can't get as comfortable as they would like because you know there there's something attached to them. So it's a a sleep shaping process where it's like okay let's come up with a routine that's conducive to sleep. One that number one your baby also responds to because if your baby doesn't like what's happening that's just going to make everything a lot harder and we're not trying to do that. So
You know, it could be a firm massage or if they receive caressing, okay, then let's work towards that. It could be, okay, keep them upright, pat them, transfer them. I mean, there's so many things with sleep shaping, but as far as ⁓ getting longer stretches of sleep, that's something that would come, you know, much, much later in some of these babies' lives. I mean, you four years in or whenever they're finally able to get off any type of machine, then we can say...
Mary Farrelly (26:50)
you
Jamie (26:55)
Let's give it a moment. Let's see what they naturally do because some babies they'll take it and be like, I'm good. It was the machines that were kind of, you know, and some kids are like, well, I'm already used to waking up X amount because you don't need to be woken up for a bag change or whatever the case is. And then, okay, well, let's kind of walk backwards, rewire that habit, give you a new habit and let's get there slowly but surely.
Mary Farrelly (27:06)
No.
Yeah, it can just take time, right? We have to meet the babies where they're at. And it's always a priority of needs. you know, in nursing school, we learned Maslow's Hierarchy of Needs. And there's certain things at the top of the triangle that are like the nice to have. Some of it might be like having like sleep training or sleep, really excellent sleep in general. But if they're not being able to be fed and oxygenating properly.
Jamie (27:24)
Yes.
Yeah.
Bye.
Mary Farrelly (27:45)
that's a nice to have, not a need to have. So sometimes I think that can be hard to navigate and like wrap your head around, but I love the idea also of sleep shaping and having as positive of a sleep environment experience as possible. What tips do you have around sleep shaping? Maybe especially for those early discharge babies when we're just figuring out life, like what are some?
Jamie (28:01)
Yeah.
.
Yeah.
Mary Farrelly (28:13)
very simple early sleep shaping habits or routines that families can work with.
Jamie (28:19)
I to keep routines very simple. I don't like them to be very long because the goal is anybody can do it, right? Mom and dad aren't home, something like that. Whoever steps in, keep it simple for them. ⁓ But also as they start to get older, they're gonna naturally wanna prolong everything, especially into those toddler years. So it's like, the more you set that expectation, like, no, like this is the routine. To this day, my kids are five and seven and we don't even do five minutes of a routine. It's like...
Two, three steps, okay, love you guys, good night, blow kisses, hugs, and we're out, and that's it. And it works for us. ⁓ So something that I always like to do with not just even preemie babies, just newborns, because you can sleep shape with newborns as well, would be, a quick routine would be bath, if it calls for bath. ⁓ Some families will do once a week, or some will just like, at least like a light sponge bath every day. If the discharge papers and everything allows for that, try some, you know, some,
some warm bath. I do like lavender. I think lavender works really well, not on their skin because they're very sensitive skin, but you know, in the air. ⁓ I do like a humidifier. I think that works really well. The tricky part would be do we do sound machines or not? I'm a huge fan of sound machines. However, for their ears, right, they're still if they're they're preterm, we know that there's still things having to work themselves through, in which case I would say do ⁓
Mary Farrelly (29:25)
Mm-hmm.
Jamie (29:46)
like a light range, super low, nothing really loud. We don't want to over-stimulate. Some kids don't like that loud, the frequencies and stuff. So just a little, little noise. White noise is okay, cause they're used to that right in the womb. But again, not very loud. Just keep it so that they just kind of hear it off in the distance. It's a familiar sound for them. ⁓ If it's a full term baby, I was still a full term baby who ended up having to be in the NICU for breathing purposes or something like that. Then at that point ⁓ you can do regular white noise. I think that works really well. But again,
Mary Farrelly (29:48)
Mm-hmm.
Jamie (30:16)
You want to protect their ears. You don't want it right by their crib or their bassinet. So you do a feeding. I like to have them feed to sleep if that's what works for them. Some kids will prefer being rocked or patted to sleep. Usually we see them fed to sleep, because especially if they were a NICU, that's usually what happened. They sleep a lot and they're always fed through a tube usually. So ⁓ that's a fine association. And then you would just transfer your baby.
Mary Farrelly (30:38)
Mm-hmm.
Jamie (30:43)
The transferring is the tricky part. That's where most parents are like, my gosh, I transferred and then they woke up. There's a sweet spot for transferring a baby. so, know, REM sleep, non-REM, right? All these things that we know as far as like adults and you as a nurse, you know, but some parents don't know. And so it has to be timed perfectly. So you want to wait at least 15 to 20 minutes before the transfer and for your baby when you do transfer them, do it. ⁓ Like if this is your baby, put their legs first.
Mary Farrelly (31:12)
Mm-hmm.
Jamie (31:12)
And then slowly lean them
in so that their head is the last thing instead of just placing the baby in because then that's when they kind of get that jerky feeling or you know, they start to realize it's so abrupt to them. They start to realize I'm not being held anymore. I'm a wig. And now we're going to do this all over again, you know, so feet first, back, feet, legs, booty, back, shoulders, head. And that usually helps the transfer go along as well, but
Mary Farrelly (31:26)
Mm-hmm
Yeah, you're on my arms now guys.
I'm gonna...
Jamie (31:42)
Keep it realistic, keep it something that's simple, bath. ⁓ If they can be in a swaddle because of that deep pressure, some kids don't like it. I'm always like, if you like it, great. If they don't like it, cool. My kids didn't swaddle. They were not big fans, so I didn't push it. ⁓ Some kids really like that. So swaddle if it's appropriate. ⁓ And then turn on some sort of little noise. It could be a lullaby even. None of these things are things that will stay forever.
At this point, it's about not only them feeling good, but you're in survival mode too. So if that's gonna help you get some extra sleep, then we do whatever we can. And then when they're of an age where, we can dig in a little bit deeper and now really start working on sleep training. Those are things that we would move away from a little bit and make it a little bit, get longer stretches.
Mary Farrelly (32:10)
Mm-hmm.
Mm-hmm.
Different time with different tools, right? And I do feel like sometimes a bedtime routine is for the baby, but I also feel like it helps the parent too, as you mentioned. Like an unregulated parent is not going to be able to regulate a baby, right? We simply, if we're up here and all crazy and we're like trying to like do this, baby's like, I'm not feeling good vibes right now.
Jamie (32:34)
Yeah. ⁓
Yeah. Right. Yeah.
And especially to when it's
mom because they're so connected that you know your baby feeds off what you're given So if you're stressed your baby's gonna be like no, I'm stressed out too now and so you have to stress out people I remember crying at the same time my son was crying throwing myself on the ground and I'm like I need to sleep. During the day it's fine cuz you don't have much to do. But at night I was like well I've been with you all day. I'm tired. I'm gonna sleep.
Mary Farrelly (33:00)
Mm-hmm.
Things get really weird
at night. It's just the truth. And I know I was like the lavender in the air, the baby might like it, but I'll definitely like some lavender in the air just to keep it all low vibes, feeling good. Because it is really hard. And at some preemies, especially talking about like white noise and those babies that have been in the NICU for a long period of time, the NICU is, we try to keep it in an environment that's appropriate, but it is not a quiet place.
Jamie (33:26)
it
Right?
Mm.
Yeah.
Mary Farrelly (33:52)
It isn't there. There's beeps. There's there's noise. There's people talking all the time. So they're expecting usually some level of noise around them. There is actually there's a playlist on YouTube that's just called Ambient NICU noise. And it has like 75000 views because there are some older babies, especially those babies have been the Nikki for months. That is their lullaby. They're used to the noise and to go from.
Jamie (33:57)
Bye.
Yeah.
What?
Oh, yeah. Right. So you wouldn't go in and change that when you meet with a consultant.
Mary Farrelly (34:21)
Mm-hmm.
Jamie (34:22)
Like, listen, I treat them, you know, other times people are like, well, we play lullabies. I'm like, we're not going to do that anymore. We're going to switch it. We're not doing that anymore. We're not going to because of the frequency. Okay, we're done. But then if it's a NICU baby, then I'm like, oh, we're going to keep it. Like, let's, you know, like very much more gracious towards, towards these babies because, know, I mean,
Mary Farrelly (34:30)
Mm-hmm.
Yeah.
Jamie (34:44)
They had a rough start. So, you know, ⁓ and if it works for the families, I'm always like, if it works for you, keep it. If it doesn't work, then we go in and change it. Usually they reach out because whatever's going on is not working. And so, you know, we do that.
Mary Farrelly (34:48)
and
Yeah, there's usually
a when you realize like, what we're doing is no longer feasible. ⁓ You have your own personal line in the sand. Like we're ready to evolve to a different chapter of our time together. But it is definitely ⁓ sometimes thinking babies in general, but with addition to the feeding and the reflux and the fact that they were, as you said, a lot of them went through a really intense time. Some of them might have had...
Jamie (35:04)
Right.
Mary Farrelly (35:22)
painful procedures and things going on. Sometimes they also just need a period of time post discharge where everything is healing overall. Like they might need to show their story. They might be harder to soothe too. They may have some of their own kind of, not necessarily trauma, but feelings in a way that they need to kind of work through and everybody kind of reset at home before we're able to kind of step into that next evolution of what you had like NICU's chapter one.
Jamie (35:31)
You're right.
Thank
Mm-hmm.
Mary Farrelly (35:51)
discharge homes chapter two, and then to kind of settle out to a certain extent. ⁓ Let's kind of touch on that a little bit too. We kind of talked about how you need to be co-regulating to a certain extent in order to help regulate a baby's emotions too. But NICU families, and this is something to talk about too, like most parents are gonna have some level of anxiety, especially around sleep and safety and all those scary things that could happen to your baby.
Jamie (35:53)
Yeah.
Yeah.
Sure.
Yes.
Mary Farrelly (36:20)
And with NICU families, feel like when I'm working with like a typical family, you can almost like show that things are safe. You know, we're doing this, the baby's breathing so comfortably, all these different things. But with the NICU family, you might've seen your baby really truly struggle to breathe or stop breathing or need to be bagged or all these different things. So you just have this different framework and babies premature are at higher risk for scarier things that can happen. Getting sick.
having apnea in the middle of the all these different things too. So there's a level of like what's healthy anxiety versus what is causing harm. So how do we help families navigate these very real feelings of grief, anxiety, and potentially even true medical PTSD that they're home with from the NICU, especially around sleep.
Jamie (37:06)
Mm-hmm. The first thing is I would always tell the families that I understand what they're going through. Right, I mean, and I think for some, it's a small group of families, of NICU families, right? We're the minority at this point. So when you find somebody that you can connect with and say, no, like I remember bringing them home and still calling a weekend, I was still calling the desk at the NICU. And be like, is this calling the pediatrician? ⁓
Mary Farrelly (37:10)
Mm-hmm.
Jamie (37:33)
Definitely feeling anxious, especially because we of what happened with our our first son I was like I have to keep him alive I have to keep him alive and I was not sleeping and I would just like stare at him and I was still doing things wrong He was in a rocker that's been since been recalled but that was the only way that I was gonna get you know three hours stretches and ⁓
Mary Farrelly (37:41)
Thank
Yeah.
Jamie (37:55)
I didn't strap him in because in my head I'm like, no, if I strap him in, what if he decides to turn and then he suffocates? No, we're going to leave him not strapped in, but we're going to swaddle from the armpits down. I don't know what that does, but in my head that made sense. You know, keep his arms free. I was a, I was a, I was a mess. And anybody around me would tell you, you're doing too much. But they also understood, well, this is part of her process. Like it makes you feel more in control to be this anal about everything. So when a family comes to me, we have a preemie baby.
Mary Farrelly (38:17)
Mm-hmm.
Jamie (38:25)
Our baby was in the NICU. ⁓ Identifying with them and saying, I've been there is huge. Setting realistic expectations. Okay, this is, we're not gonna go in and change anything you're not ready to change. What are you wanting to work on? Like how do you see yourself getting there? What have you tried? Has the pediatrician cleared for these types of things? Okay, great. Then we're gonna take it little by little. It's a much more slower process. Number one, babies need it, but also,
Parents need need to take it a little bit slower than a family whose baby did not have any NICU experience even moms who have had full term babies No, NICU, but their birth was Not what they wanted. It was traumatic to them even that in cases like that. You have to take things a little bit slower so that they Are more receiving of the process and a lot more comfortable because as much as they need it They're still uncomfortable and nervous throughout throughout everything right? And so my job is to walk through it with you
Mary Farrelly (39:18)
Mm-hmm.
Jamie (39:22)
Hold your hand, reassure you, make sure that you're being honest because I'm gonna be honest and if you're uncomfortable then we can't do it, right? We're not gonna make anybody do something that they don't wanna do. And then setting the expectations of okay, this is where we're gonna start and it's gonna take a little bit longer but sleep is possible. However, we need to be realistic about where your child's specifically at, where they are with sleep. And so we cannot compare this child of the same adjusted age as another child because.
Temperament plays a big part in it routine plays a big part in it. Some kids are flexible some kids are Not right. My daughter didn't care about anything. She's like, I'm just happy to be here and my son is very rigid You know very schedule driven ⁓ Being raised the same way, but they're just personalities, right? So you have to take personality into account and express to the parents like I totally get what you're coming from But at the end of the day the child takes the lead and so what is your child doing? Okay, then we're gonna work with that
Mary Farrelly (39:57)
Mm-hmm.
Mm-hmm.
Mm-hmm.
Yeah, I love that. is important to sometimes realize as a parent that like you are setting an environment, but you're not controlling, right? And sometimes we have to listen to what our baby's trying to tell us. sometimes we're holding kids and babies back to a certain extent because it feels safe to us, and then acknowledging that that's okay. Like you're still in survival mode. That's okay. And...
Jamie (40:38)
Yes, it is.
Yeah.
Mary Farrelly (40:47)
Let's be curious about this. Let's explore. Let's see the next steps and things like that too.
Jamie (40:52)
Yeah, and
I'll always try and encourage dad to take over because ⁓ moms are moms, right? Like we feel it differently than dads do. And so most of the time, once mom is removed from being an option, these babies are doing things that they never thought. And then mom often will feel bad because she's like, I was doing it wrong. I was holding them back. And I'm like, no, you're not. You're just their mom. And they relate so much with you. So take a step back, leave the house. Moms have left the house.
Mary Farrelly (40:56)
Mm-hmm.
Mm-hmm.
Jamie (41:23)
Leave me and dad, we're messaging back and forth in real time. You know, don't be in the group chat because don't just disengage. ⁓ And once we're in a good spot, we'll bring you back in and we'll, know, and then That helps a lot with moms because you know, if you're stressed out and you're thinking all these different things, which is of course natural, then it can hinder the process because you're not giving your baby a moment to see what they can do. And like you said, we'd sometimes
Mary Farrelly (41:28)
Right?
Mm-hmm.
Jamie (41:51)
Hinder that process because of what's natural to us, but baby could be giving signs of what's working what used to work Isn't working anymore. I need a second. I just don't know how to do it right and so okay dad step in ⁓ Sometimes it's mom, but usually it's dad that little that'll take over and then we'll do it that way Yeah
Mary Farrelly (41:59)
we have.
Yeah, is it. It's just
it is a different, a different dynamic and a different relationship, especially coming from the NICU. That dynamic is often there too. Like the NICU tends to be very, you know, mother baby dyad because you are a postpartum couplet. Like it's there's the relationship with feeding and things like that too. So I think that allowing the partner, the dad, whoever second caregiver is in that baby's life to be able to
Jamie (42:25)
Right.
Yeah.
Mary Farrelly (42:37)
shine in this moment too. Like take over this different dynamic and think it's bonding in a different way. I think it's a really it's like almost like a win-win overall even though it can feel different sometimes like doing something different will feel maybe uncomfortable but again that curiosity like let's be curious about what happens when we're not gonna like
Jamie (42:38)
Yeah.
Right, bonding with them.
It is.
Mm-hmm.
Right, yeah.
Mary Farrelly (43:01)
be crushed if something doesn't go according to plan. And that happens in the NICU too. At a certain point, we realize that the babies are in charge, right? We can help, we can create an environment, we can be listening to them and trying to tweak things here or there. But if there was a manual, especially when I'm feeding, if I could show a baby a video about how to eat appropriately and suck, swallow, breathe, and they can go home and that'd be great, we would be doing that. I cannot.
Jamie (43:04)
Right.
you
Mary Farrelly (43:30)
force a baby to know how to eat at this exact time. I can create positive environments and set building blocks and do feed shaping and then we get there. But to expect it to be like here and then there in one second is different.
Jamie (43:34)
Right.
Right, it's the same with sleep. It's the
same, like I love that you said that because they go hand in hand. Your baby's not eating or eating. They're not gonna be able to sleep because they're gonna wake up because they're hungry. It's cyclical, right? So when you say, okay, they're not robots. It would be nice if they came with a manual. I mean, I would be out of a job if they came with a manual. You know what I mean? But.
Mary Farrelly (43:53)
Mm-hmm.
They're not.
Mm-hmm.
Hahaha
Jamie (44:13)
There's even the things that are online. It doesn't pertain to a specific situation. And so that's why I love what I do because I can come in and say, okay, it's everything's based on your child, right? Child A, same situation down to a T, but they're receiving it a little bit differently. Our job is not to force them to sleep. My job is to create the environment, put everything in its place, work through it. And then it's their job to receive the sleep.
Mary Farrelly (44:23)
Mm-hmm.
Mm-hmm.
Jamie (44:43)
That could take one night, that could take two weeks, that could, you know, it just really depends on the child and stronger personalities, well, you know.
Mary Farrelly (44:48)
Have a
Mm-hmm.
And we taught you just mentioned, and this just popped a question into my head too, because this is also a very common part of ⁓ many NICU babies is multiples and especially twins, triplets, twins and triplets mostly or more if that's a whole different ballgame. with preemies and twins sometimes go hand in hand, not always. So how do you have any quick tips for navigating?
Jamie (45:06)
Right.
Yeah.
Mary Farrelly (45:18)
life at home around sleep especially with more than one baby.
Jamie (45:22)
Right.
So for multiples, the first thing I would say is have your partner, a grandparent, somebody like that to sort of tag team everything. After that, then I would say start, they're usually already on a schedule, start shifting it a little bit where there's at least a 15 minute grace period. That gives you enough time to have one that's fed, the other one's usually sleeping.
Mary Farrelly (45:41)
Mm-hmm.
Jamie (45:45)
then swap them out. The other one's going, starting to go to bed. Then you can start feeding the other one. Usually I see it being about 15 minutes. Some need a 20 minute gap and that's okay. Even a 30 minute gap is okay. I mean, ideally you would like them to be on the same schedule or close enough to where then you can also call it a night and have your own moment and relax and just decompress from the day. ⁓ So if they're on the same schedule, if the feeding
If they're not on a machine, at that point I would say slowly drift the schedule to where there's at least a 15 minute gap and see if that helps. And usually they'll kind of just follow suit and as long as everything of course health-wise is fine, then once you start working with them, there'll be like a 15 minute gap at least and that gives you a brief period to deal with one and then move on to the next and then both will be asleep.
Mary Farrelly (46:22)
Hmm.
bright at the end and both of them awake and one of them mad because you're not dealing with their needs and that exact moment too. I like the idea of a grace period. Grace in this whole experience. Life in NICU is all about grace for everybody involved. So if families want to work with you or are curious about sleep shaping and sleep training, especially knowing that you work so closely with NICU families, tell us a little bit about your work and how families can get in touch with you.
Jamie (46:41)
Yeah.
Yeah. Yeah.
Yes, that's the word.
Yeah.
So I work specifically with PreMe Babies on a parenting platform called iHelpMoms. It's a virtual platform and it allows for us to take it step by step because what we would be doing is sleep shaping, right? So we're just laying foundation and doing those building blocks that you were talking about. And so I offer those services on ihelpmoms.com and I will be more than happy for all your listeners. I do have a like a quick little NICU sleep PreMe Baby guide.
Mary Farrelly (47:37)
Yeah.
Jamie (47:37)
I'm
just kind of laying a little bit of foundations on the firm pressures and things like that. More than happy to send that over so that your listeners can receive that. ⁓ And then my business is called Little One Sleep Society. And so you could find that on Instagram. And that's where I'll have reels and things like that, giving more information on little things that they can try. And then if they're like, you know what, we just need more support. Message me and we'll set up a call and then go on to iHelpMoms and be able to serve you guys that way.
Mary Farrelly (48:03)
That's amazing. Well, thank you
so much for being on the show for my one last closing question. So if the person who's listening to this is a parent who's exhausted and scared and unsure of where to start, is one piece of encouragement or one tiny little step, one quick win or, really just that like moment of like, you can do it that you want them to take with them as they head into their sleep tonight.
Jamie (48:27)
Yeah.
Well, the first thing is you can do it. They've already
proven that they're warriors. So your baby's got this. It can take some time, but everything is a season and we will move past from what you're currently in and moving into, you know, a little bit more of a relaxed state, not as anxious, right? And then something that you can try super simple when you do get home is, you know, a room environment. Let's start with at least a room environment, a dark room or a red light.
Let's start with some, you know, ambient noise if that's what they heard in the NICU or move into soft white noise, move into maybe rain sounds, making sure that it's not overstimulating to them, but more on the relaxing side. And then as far as feeding to sleep, go ahead and feed to sleep. It's not anything that you can't get back from when it's time to move to move past it, if you want to move past it. ⁓ But there's great resources out there, you know, get your, get a team together, ask your local, you know, NICU
Nurses and say, hey, who do you know? Do you know anybody that I can reach out to when it comes to sleep after here? ⁓ Because part of it is you want to click with the person that you're working with. So get a little village, a little resource of saying, OK, this is who I can contact when it comes to sleep. And make sure that they understand pre-sleep a little bit before you jump into anything. Ask those types of questions. You have every right. And you want to be comfortable with whatever decisions you make after you don't have doctors and nurses kind of guiding you, you know?
Mary Farrelly (49:39)
Mm-hmm.
Yep. That is one of those gaps that I see NICU Doulas stepping into too, especially those that are doing in-home support in those early-based homes, is having someone who can be your cheerleader as you step into this next year.
Jamie (50:05)
Yeah.
Right. Yeah, because you always
think you're doing everything wrong. Just in general. And then, you know, they're released from the NICU and then you're like, I have to get it right or something's going to go off the rails. And so to have somebody be like, you're OK. Somebody who knows what they're doing, a doula who, you know, specializes in NICU babies. OK, it's like that allows for parents to just get an extra hour of sleep if they need to get an hour of sleep or, you know, and that and that in turn.
Sleep is underrated and that in turn allows you to be more present, more alert, happier, right? If you're already anxious and you're not sleeping, well, it's just gonna get, do you know what I mean? Like it's not gonna get good, right? So, you know, having somebody like that would be, amazing. Get some sleep, refresh, get back in the game when you're awake, you know? Yeah. And am.
Mary Farrelly (50:50)
It doesn't
Yep, and the NICU's only beginning and you're doing a great job. We're
all doing a great job. Older kids and doing all the things. So thank you so much for being with us today, Jamie and hopefully we'll talk again soon.
Jamie (51:07)
Yes we are!
Yes. Thank you, Mary.
Yes, I appreciate it. Thank you so much.