Valerie Legendre is an occupational therapist focused on supporting premature infants in the Neonatal Intensive Care Unit (NICU). She equips families with knowledge and skills to foster their baby’s development highlighting skin-to-skin contact and breastfeeding. Her aim is to ensure that families leave with the confidence and understanding they need for a smooth transition home.
This episode is dedicated to Carmen, our niece, who lived her first
:weeks in the neonatal intensive care unit
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Catherine:May marks Mother's Day month in around 90 countries.
Catherine:Well, it's a wonderful time to honor mothers absolutely everywhere.
Catherine:And to help in this celebration, I am thrilled to welcome my
Catherine:guest today, Valerie Legendre.
Catherine:She will provide insights into what a neonatal intensive care unit is like
Catherine:for premature infants, as well as how her role as an occupational therapist
Catherine:supports both mothers and their children.
Catherine:Valerie works at Presbyterian Hospital in the United States, and
Catherine:many people may not realize just how crucial an occupational therapist is
Catherine:in the neonatal intensive care unit.
Catherine:Occupational therapists offer hope and support to both mothers and babies,
Catherine:valerie Legendre, welcome to the show.
Catherine:Oh, good morning.
Catherine:It's so good to see you.
Catherine:Good to have you on the show, and to learn about something
Catherine:that is not well-known worldwide.
Catherine:Now, you are an occupational therapist, and we are here to celebrate
Catherine:moms, and I know you are a mother yourself, so Happy Mother's Day month.
Catherine:Absolutely.
Catherine:So let's get started.
Catherine:Was there something that brought you to becoming an occupational therapist, or
Catherine:was it something you just knew early on?
Valerie Legendre:No, actually occupational therapy was
Valerie Legendre:kind of an unknown for me.
Valerie Legendre:It was a bunch of series of life steps and I kinda collided with an individual
Valerie Legendre:during college that introduced me to it.
Valerie Legendre:I always knew I wanted to do something with children and infants, and so
Valerie Legendre:all of my experiences led up to that.
Valerie Legendre:But it wasn't until I was in the midst of college that I ran into someone when I
Valerie Legendre:was volunteering that, that really showed me the ropes and talked to me about it.
Valerie Legendre:So yeah, it was a journey.
Valerie Legendre:It was a process.
Catherine:Wow.
Catherine:So what did you learn about it that made you really wanna go towards that
Catherine:from that, from that conversation?
Valerie Legendre:Yeah, so originally my interest was medicine.
Valerie Legendre:Growing up I did some volunteer work with within nursing and just
Valerie Legendre:didn't really wanna do all the pokes and blood and all that stuff.
Valerie Legendre:And so I thought, "Wow, I really love teaching," so I went to get
Valerie Legendre:a degree in preschool education.
Valerie Legendre:And when I was in the classroom with 20-some kids, I realized,
Valerie Legendre:gosh, I don't know if I enjoy teaching 25 kids all at once.
Valerie Legendre:So I really, really enjoyed the one-on-one time that I would get with kiddos.
Valerie Legendre:And so, Different life circumstances and so, everything kinda landed and
Valerie Legendre:pushed into a child development degree.
Valerie Legendre:Um, Part of that was doing some volunteer work, and so I did that at the Child Life
Valerie Legendre:play area at UNM and at Presbyterian.
Valerie Legendre:And so I really enjoyed learning how to bring play into the aspects of
Valerie Legendre:helping with children process the medical equipment and the medical
Valerie Legendre:experience and that really intrigued me.
Valerie Legendre:So for a moment I thought, "Well, maybe I'll become a Child Life
Valerie Legendre:specialist." So, I was actually on my way to volunteer with the Child Life
Valerie Legendre:program when I had an individual stop.
Valerie Legendre:We were at a stop walk to cross the street, and she was going to do some
Valerie Legendre:volunteer work, and she... I don't even know how it came up, but she was...
Valerie Legendre:she started talking about this degree she just signed up for with occupational
Valerie Legendre:therapy, and our lives were very similar, our interests were very similar, and she
Valerie Legendre:convinced me that, "Gosh, you love to teach one-on-one. This would be teaching
Valerie Legendre:little ones . You love to do the play therapy, and there's all sorts of play and
Valerie Legendre:fun when it comes to helping kids achieve their milestones and their occupations."
Valerie Legendre:And so then I just was looking at the pay difference was huge, too.
Valerie Legendre:So, it just kinda navigated that route.
Valerie Legendre:At the time, I was very interested in infants and NICU, and that
Valerie Legendre:was an arena at the time, too, that OTs were branching into.
Valerie Legendre:So all those things kinda collided and pushed me towards that direction for
Valerie Legendre:furthering my education after I finished my bachelor's in child development.
Valerie Legendre:It
Catherine:Valerie, I love that story because you, you went full
Catherine:circle into finding your niche i- in life, and that is awesome.
Catherine:And that right there, that's inspiring for people to hear that you started
Catherine:in one area because you love children, you wanted to work with children, but
Catherine:maybe not in that classroom setting
Catherine:. So I'm so glad you're here as occupational therapist and there's so much we do
Catherine:not know, so much I don't know, and listeners don't know worldwide about
Catherine:occupational- occupational therapist.
Catherine:You said yourself that it was an area that you just didn't know about.
Catherine:So let's go to this question of is the difference between physical
Catherine:therapy and occupational therapy?
Valerie Legendre:Yeah.
Valerie Legendre:Well, in pediatrics we don't see
Valerie Legendre:as big of a difference as we do in the adult population, for sure.
Valerie Legendre:But if you look at the broad sweeping s- span of it, physical therapists obviously
Valerie Legendre:work with individuals on strengthening and getting back to motor skills, and a lot of
Valerie Legendre:it is expertise in ambulating and walking and running and all those great things.
Valerie Legendre:OTs is a little broader in the sense that we help individuals
Valerie Legendre:get back to what we call ADLs, activities of their daily living.
Valerie Legendre:So for adults, that might be dressing or bathing or those kinds of things.
Valerie Legendre:But when it comes to kiddos, obviously they do dress and, and get bathed as
Valerie Legendre:well, but there's so much incorporating of parents as well in that dynamic.
Valerie Legendre:There's like this nice little dyad of helping parents doing
Valerie Legendre:those things, as well as play.
Valerie Legendre:And then a new realm for me, which wasn't on my radar exactly when I
Valerie Legendre:first started but then kind of migrated was even moving into the infant
Valerie Legendre:population, and there's a lot of OTs that work obviously now in the NICUs.
Valerie Legendre:But with infants and that is really focusing a lot more on helping the parents
Valerie Legendre:and their activity of the infant care.
Valerie Legendre:Feeding and dressing, bathing their infants, bonding,
Valerie Legendre:all those things as well.
Valerie Legendre:And so, really the unique piece I think of OTs is, is just that
Valerie Legendre:functional activity and that daily living process, and then working
Valerie Legendre:Within those systems and within all of those pieces to kinda help that come
Valerie Legendre:together for either kiddos, infants, to adults and older individuals, so.
Catherine:So is it mostly premature babies that you work with?
Valerie Legendre:Yes.
Valerie Legendre:So in the NICU, a majority of them are born prior to the, the term date.
Valerie Legendre:There are some infants born that have other struggles that are in that term
Valerie Legendre:bracket, and then there are infants that can stay there for a while.
Valerie Legendre:But yes, it's, it's infancy in the NICU that brings them
Valerie Legendre:in upon delivery typically.
Catherine:What does that look like So, so my niece was born
Catherine:prematurely, and unfortunately we did not have OTs at that hospital.
Catherine:But she would stop breathing at times, and so what does the occupational therapist
Catherine:do during those times to help mother and, and when you're bringing the baby home?
Catherine:What kind of work is entailed in doing this to keep the baby breathing?
Valerie Legendre:Yeah.
Valerie Legendre:So, I guess if you're looking at just the breathing component
Valerie Legendre:for occupational therapists we do help facilitate a lot of that.
Valerie Legendre:So we're in New Mexico, and our elevation is higher, so a lot of
Valerie Legendre:our babies are actually on high respiratory supports for longer--
Valerie Legendre:and long durations than other areas.
Valerie Legendre:And so that's actually one area that we have to have a keen eye
Valerie Legendre:for and a therapeutic handling and touch and expertise in because
Valerie Legendre:our babies are on higher supports and systems for oxygenation here.
Valerie Legendre:So for us with OT, if we're just looking at airway and breathing early on, we
Valerie Legendre:can help support families as they want to touch and, and hold infants with,
Valerie Legendre:ET tubes or things that are helping to actually give them those breaths.
Valerie Legendre:A lot of times there's extra maneuvering.
Valerie Legendre:We work with our, closely with our respiratory therapists and our nursing
Valerie Legendre:to get infants skin-to-skin, which is just that holding baby chest-to-chest
Valerie Legendre:and holding for the very first times.
Valerie Legendre:We help with that process.
Valerie Legendre:As well as there's a respiratory support called CPAP that has this-
Valerie Legendre:whole apparatus of the contraptions on their nose and then straps and chin
Valerie Legendre:straps and a hat and the whole process.
Valerie Legendre:And we're aware of the fact that that also then, although it's life-saving,
Valerie Legendre:puts pressures on their jaw and it puts pressures on their nose and it fills
Valerie Legendre:their bellies up sometimes with air.
Valerie Legendre:And so, we can help with positioning as well as different strategies to
Valerie Legendre:engage their abdominal core and all those things because even how their
Valerie Legendre:diaphragm moves, all those things change.
Valerie Legendre:So, we really have expertise and extra learning in the processes of
Valerie Legendre:how those respiratory supports Can alter an infant's normal movements
Valerie Legendre:and body mechanisms and supports to kind of help those move along a more
Valerie Legendre:what we call normal trajectory, and then provide supports with families
Valerie Legendre:on those strategies as well so that they can help them move forward.
Valerie Legendre:So those are like the more extreme respiratory supports
Valerie Legendre:that we see, like oral intubation typically and then the CPAP.
Valerie Legendre:But we use those extra skills and learning to help educate family for those things.
Valerie Legendre:I think overall, so respiratory is like a small piece too in the
Valerie Legendre:grand scheme of what we offer.
Valerie Legendre:So I don't know if it would be helpful to kind of go through some
Catherine:Yes.
Catherine:Yes, because all of this is hopeful and educational
Valerie Legendre:Yeah.
Valerie Legendre:So just prefacing, when I graduated from occupational therapy school,
Valerie Legendre:I had a, a great knowledge of infants and child development.
Valerie Legendre:My bachelor's degree is infant development.
Valerie Legendre:However, not very many schools dive into the in-depth of anything
Valerie Legendre:under the 40 weeks, right?
Valerie Legendre:So learning all of the gestational expectations for motor and development
Valerie Legendre:was something that we went and did extra courses in, and we had extensive
Valerie Legendre:mentorship in so that we could really learn and know those systems.
Valerie Legendre:And so all of us with in our team have done a lot of extra courses to get
Valerie Legendre:certified in neonatal therapy, so we're all certified neonatal therapists, CNTs.
Valerie Legendre:So that extra knowledge and information is kind of the core and crux to
Valerie Legendre:help us as well, Be able to support these families in these unique ways.
Valerie Legendre:So in that knowledge, we're educators and we're educating
Valerie Legendre:family from the very beginning.
Valerie Legendre:So the earliest right now in our hospital that we can see is twenty-two weeks
Valerie Legendre:So a twenty-two weeker we would get an evaluation order on and we help with
Valerie Legendre:families understand skin integrity and preservation, understand all of the
Valerie Legendre:oxygen supports that they may have and then first touches, first diapers, first
Valerie Legendre:cares, all those things as well as once they're stable enough, doing the holding.
Valerie Legendre:And so we work through each week basically uh, depending on when
Valerie Legendre:they're born and then how they move forward in their development.
Valerie Legendre:We support the families in that education information with a huge emphasis on touch
Valerie Legendre:and handling as well as information on how to support their brain development
Valerie Legendre:and their development overall with what to expect all the way through.
Valerie Legendre:So that is a process that we are supporting families and educating families
Valerie Legendre:from start to finish with that piece.
Valerie Legendre:There is a, a wonderful quote in one of our i-- courses that we
Valerie Legendre:had taken was to touch a premature baby is to touch their brain.
Valerie Legendre:And so there's a, a heavy emphasis on the power of touch for
Valerie Legendre:families as well as to the infant.
Valerie Legendre:And so we're very cognizant of all of those things.
Valerie Legendre:Then we also support early pre-feeding.
Valerie Legendre:Obviously, infants have reflexes early on in utero that they would be utilizing in
Valerie Legendre:the safeties and comfort of the womb and they will be doing that externally with
Valerie Legendre:extra tubes and and touch that's medical.
Valerie Legendre:So we work early on on helping families create both the external environment of
Valerie Legendre:calm states and touch and positive touch and then pacifiers and non-nutritive sucks
Valerie Legendre:as well as exposures to scent like that mother's scent with scent cloths, . So
Valerie Legendre:we, we, we make a heavy emphasis too on that early feeding because feeding
Valerie Legendre:becomes their primary job later on both for family members to learn as well as
Valerie Legendre:infants, and it's not as smooth as when they have all those medical interventions.
Valerie Legendre:So we try to, to create that education and knowledge early for the feeding.
Valerie Legendre:Feeding is both bottle and breastfeeding typically in the unit,
Valerie Legendre:and so we, we have a good knowledge of helping support that as well.
Valerie Legendre:One of the things I personally did this year was seek out the certified
Valerie Legendre:lactation consulting title and information just so that I can also
Valerie Legendre:help families along that trajectory for breastfeeding in more detail.
Valerie Legendre:So we have breastfeeding, bottle feeding expertise and then and then
Valerie Legendre:we also support the bathing process.
Valerie Legendre:So we can help support whatever adaptations we need early on for
Valerie Legendre:whether that's a bed bath and sponge bath to all the way through the skin
Valerie Legendre:integrity changes throughout the process.
Valerie Legendre:And so knowing when we can use soaps and what types of soaps and
Valerie Legendre:water, all that is is guided and, and supported and provided family
Valerie Legendre:education on throughout as well.
Valerie Legendre:So within each and every one of these tasks we're helping support,
Valerie Legendre:educate, and provide the caregiver the knowledge and the confidence
Valerie Legendre:to take that task on themselves.
Valerie Legendre:To kind of pass that baton slowly over, "Okay, now you're-- you, you're
Valerie Legendre:really good with getting your baby out and holding, and now you get to
Valerie Legendre:do that on your own," and supporting the environment and everything to
Valerie Legendre:kind of help them through that process so that they can become that primary
Valerie Legendre:caregiver for the infant in that way and then advocate for them a-as well.
Valerie Legendre:So, a lot of education and knowledge again on that... And I say dyad 'cause
Valerie Legendre:you have to know the caregiver's role, support that, as well as what's
Valerie Legendre:the infant's abilities and role.
Valerie Legendre:And then you have to know how that all interacts with the environment, which
Valerie Legendre:is this unnatural medical facility space with that limitation too.
Valerie Legendre:And so, knowing all of those systems and how they interact with
Valerie Legendre:each other, and they can change moment to moment and day over day.
Valerie Legendre:We're just kind of working within that, that construct to help support
Valerie Legendre:the family as a one unit get from start to finish and get home.
Valerie Legendre:And our goal is that families can go home and know all the things to do to
Valerie Legendre:support their infant's development as well as to have been bonded and supported
Valerie Legendre:throughout a process when they're in such an unnatural environment to kind of finish
Valerie Legendre:that growth process to get them home.
Catherine:I love that, to get them home.
Catherine:, it gives me goosebumps just when you think about it, because I
Catherine:remember my niece being there.
Catherine:So occupational therapists provide the education, but also that hope,
Catherine:and that hope is also what you said is that confidence building.
Catherine:Because when the caregiver is able to go home and care for the
Catherine:baby, they have that confidence, which confidence is part of hope.
Catherine:We, we build hope based on not just confidence, but on everything around
Catherine:us, on you, what you're providing.
Catherine:So is there a follow-up?
Catherine:Do they come in to see you once they leave the neonatal care?
Valerie Legendre:Yes.
Valerie Legendre:We have a developmental follow-up clinic and they do have a scheduled
Valerie Legendre:appointment to come back and be seen every three months or so, and then
Valerie Legendre:for the first couple years of life as needed, just to make sure they're
Valerie Legendre:hitting milestones, doing the things they need to, family still has all the
Valerie Legendre:answers and, and supports they need because obviously as the baby grows
Valerie Legendre:and changes, the needs change too.
Valerie Legendre:And then also making sure that they're connected to the resources within
Valerie Legendre:our community and, and that there's not any gaps there as best we can.
Valerie Legendre:Our state has a lot of rural areas, and so, just making sure that everybody
Valerie Legendre:has what they need as best that we can,
Catherine:that is so awesome.
Catherine:And I wanna go back to, , breastfeeding., People are under the misnotion
Catherine:that breastfeeding happens very quickly and very naturally.
Catherine:Oftentimes that's not the case.
Catherine:And so occupational therapists are needed to help with that.
Catherine:And I know that World Health really pushes breastfeeding worldwide
Catherine:because of that immunity building aspect through breastfeeding.
Valerie Legendre:Yeah.
Valerie Legendre:So I guess breastfeeding starts for us w- from day one on the NICU in the sense
Valerie Legendre:that depending on the age breast milk is definitely the number one source of food
Valerie Legendre:that we want to support for these infants.
Valerie Legendre:There's a lot of data and literature now that supports that breast milk
Valerie Legendre:is best for their gut as it develops.
Valerie Legendre:It really reduces the cases of NEC and other things that can happen to an
Valerie Legendre:infant gut that's been born premature.
Valerie Legendre:So we have donor milk that we can offer for infants as well as moms are
Valerie Legendre:encouraged and supported to start pumping early on even before their
Valerie Legendre:baby is at the, the level of being able to latch and, and feed on their own.
Valerie Legendre:And so oftentimes our moms have a long course of breastfeeding where they've been
Valerie Legendre:on a pump doing pumping eight times a day.
Valerie Legendre:Every three hours around the clock waking up and, and, it's a full-time
Valerie Legendre:job for them just to provide the milk for their babies while they're there.
Valerie Legendre:And then we also really encourage that the process of infants
Valerie Legendre:continuing that strength that they have of smell when they're born.
Valerie Legendre:They all come out knowing mom's smell and being really connected to that.
Valerie Legendre:And so we have scent cloths that mom can, can wear in between and put in the
Valerie Legendre:ice sled or wherever the infant is so that they can continue to smell mom and
Valerie Legendre:that that can continue to be encouraged because we know with breastfeeding
Valerie Legendre:that a big piece of being able to get proper latch is that sense of smell.
Valerie Legendre:And so we really encourage that too along with body positioning
Valerie Legendre:and that kind of thing.
Valerie Legendre:So they have the better motor capabilities of having that open
Valerie Legendre:mouth and jaw posture, all the things they need to, to do a latch.
Valerie Legendre:And then, yeah, when, when we get to that process where infant is ready for
Valerie Legendre:feeding and then, and breastfeeding, we help with that process too.
Valerie Legendre:A lot of that is early skin to skin and getting mom used to moving a
Valerie Legendre:breast and positioning as well.
Valerie Legendre:One of the, I would say lenses that OTs bring to the process of early
Valerie Legendre:breastfeeding and especially premature baby is our ability to adapt the
Valerie Legendre:environment as well as looking at mom and baby's body postures and positions and how
Valerie Legendre:that can really be modified to encourage the proper movement and the proper
Valerie Legendre:latch and, and, and all of those things.
Valerie Legendre:So, I I love, love, love breastfeeding.
Valerie Legendre:It's one of my passions and one of the things that I love to see is going
Valerie Legendre:into a mom that has a baby that's really struggling and they can't get,
Valerie Legendre:figure it out and we simply add a different pillow and add supports at
Valerie Legendre:the feet and move baby an inch down or a diff- a different position and baby
Valerie Legendre:is able to latch more successfully and have more of a calm state.
Valerie Legendre:It's a lot of fun to watch just the little adjustments and how those can help.
Valerie Legendre:I would say there is also a population of our late-term preemies that
Valerie Legendre:struggle a lot with breastfeeding.
Valerie Legendre:They get the nickname great pretenders because w- they're in these bigger
Valerie Legendre:bodies and they're so close to due date and families anticipate that
Valerie Legendre:they're just gonna behave like a term baby would, and they tend to, to not.
Valerie Legendre:Many of them struggle with energy and are very, very sleepy which also makes
Valerie Legendre:positioning them really well and heavily supported to be much more important.
Valerie Legendre:They can be a little more limp noodles and have a hard time
Valerie Legendre:sustaining that endurance.
Valerie Legendre:And so that population, I think gets all of us a little bit 'cause everyone
Valerie Legendre:looks at them like, "Oh, you should do great," and they're, like awake
Valerie Legendre:and going and then fatigue so fast.
Valerie Legendre:So I, I think, it, it creates a lot of discouragement for sure for families
Valerie Legendre:who are thinking, "Gosh, we're so close to due date and we're gonna get out of
Valerie Legendre:here," and then they fall asleep and they, they don't take a full feeding.
Valerie Legendre:So we definitely are supportive along the whole processes for it.
Valerie Legendre:But that group and population can sometimes be more discouraging
Valerie Legendre:just because family is walking into it thinking, "Gosh,
Valerie Legendre:We're gonna get out of here, and they're gonna be these great little feeders,"
Valerie Legendre:and they look like term babies, and they act like little preemies, and they
Valerie Legendre:need a little more support and a little more time and a little more patience.
Valerie Legendre:A- and sometimes more adaptations is, like I said, more supports
Valerie Legendre:positioning-wise at just to get latched on a breast and to do the job.
Catherine:Now, worldwide, there seem to be more premature babies
Catherine:born every year than in the past.
Catherine:Is that because we have better medical where we're able to save the baby what
Catherine:is the research saying about this?
Valerie Legendre:I haven't really kept abreast of the most recent research.
Valerie Legendre:I did run across an article but didn't read it in full depth, but it, it
Valerie Legendre:did say in the year 2025 that we had record numbers of premature births.
Valerie Legendre:And so I think it's a combination of our medical expertise.
Valerie Legendre:When I first started OT in NICU, we-- 24 weeks was the earliest we were
Valerie Legendre:intervening and now it's down to 22.
Valerie Legendre:We have more technology and more supports to, to keep younger ones
Valerie Legendre:going and blessing, but also, it, it definitely means that we have
Valerie Legendre:more babies that are in our NICU.
Valerie Legendre:And then also just other anomalies and things from environmental.
Valerie Legendre:Who knows?
Valerie Legendre:I don't...
Valerie Legendre:I'm not really sure what exactly is causing them.
Valerie Legendre:I know our NICU is also filled with babies that aren't just born early but might
Valerie Legendre:have other diagnoses, cardiac anomalies or, or things like that, the diagnoses
Valerie Legendre:that that makes them need a little m-more medical interventions to get home.
Valerie Legendre:So I think it's probably a combination of all of the things.
Valerie Legendre:But again, I, I haven't really looked into too de- too much depth of the
Valerie Legendre:research that's current on explaining why those, those might be happening.
Catherine:I know it's different for all of the babies, but what is the
Catherine:average time span if a baby is born at 22 weeks early, how long would a
Catherine:family be seeing a stay in the hospital in the neonatal intensive care unit?
Valerie Legendre:always say our goal obviously is by due date
Valerie Legendre:but a baby that's born much earlier and has more respiratory supports
Valerie Legendre:or, or struggles in the respiratory department tend to stay,
Valerie Legendre:after they pass that due date.
Valerie Legendre:And a lot of times that's working on breathing, that kind of thing.
Valerie Legendre:If they have surgeries while they're in NICU for any reason, that
Valerie Legendre:tends to increase their length of stay
Valerie Legendre:You're not just growing, but you're also recovering from a medical intervention.
Valerie Legendre:So every course is different obviously.
Valerie Legendre:But we always say goal is typically by your due date, if courses, just
Valerie Legendre:to grow and, and gain and all that.
Catherine:Oh, that is just so interesting and so much hope.
Catherine:What does that look like when they take the baby home?
Catherine:Is
Valerie Legendre:Our criteria for home would be the oxygen level has to be one
Valerie Legendre:that can be supported on a home system.
Valerie Legendre:, they have to be eating all our food by mouth or if they end up with a G-tube,
Valerie Legendre:then be able to have the, the food in them, , based on their nutrition,
Valerie Legendre:Assessment and then be gaining weight.
Valerie Legendre:Obviously then families have
Valerie Legendre:To go through all of their processes.
Valerie Legendre:Some families will room in to kind of get at the hang of how things are
Valerie Legendre:going, and then go through all the mark-offs that they have to for safety.
Valerie Legendre:But those are the , main variables.
Valerie Legendre:So we will have babies that can go home before their due date 36, 37 weeks,
Valerie Legendre:whatever it lands in, where they're eating and growing, gaining, and, and
Valerie Legendre:breathing on their own in a safe manner.
Valerie Legendre:So that's really the medical criteria to go
Valerie Legendre:home.
Valerie Legendre:So we do for sure have babies going home before due date.
Valerie Legendre:But I always encourage... Or in my mind, by due date, that typically is
Valerie Legendre:when all of those things iron itself out on a typical course, unless, like
Valerie Legendre:I said, there's other variables the baby is having to work through that
Valerie Legendre:kind of extends it past that 40 weeks.
Valerie Legendre:We do have interventions and, and infants that are born before anything
Valerie Legendre:earlier than that 37 weeks, we, we talk to families about - an adjusted age.
Valerie Legendre:So an - adjusted age would be, I always tell families,
Valerie Legendre:everyone remembers due date.
Valerie Legendre:So think about your baby being born on due date.
Valerie Legendre:That's what their motor expectations and their output expectations are for us.
Valerie Legendre:So they will get that adjusted age until they should catch
Valerie Legendre:up by the time they're two.
Valerie Legendre:So the adjusted age gives everyone kind of a gauge of are they starting
Valerie Legendre:to catch up to their peers based on their birth date, as well as not
Valerie Legendre:over-expecting something of a baby, especially when they first get home.
Valerie Legendre:So if baby just gets home and they're hit that due date, then
Valerie Legendre:I would expect motor-wise and interaction-wise, endurance-wise,
Valerie Legendre:feeding, everything to kind of align more with a newborn day one than Maybe
Valerie Legendre:they've been alive for two months.
Valerie Legendre:I don't expect them to be hitting a two-month milestones.
Valerie Legendre:Now, we will see what we call splinter skills, where maybe that
Valerie Legendre:baby starts to pick up and, and is like its peers in some arenas.
Valerie Legendre:And the earlier you're born prematurely, the more things you get to work on.
Valerie Legendre:You have all those medical interventions and growing in an external medical
Valerie Legendre:environment that we have to then work towards hitting those skills.
Valerie Legendre:And then even within those skills, premature infants tend to engage
Valerie Legendre:different muscles with their motor output and also have different sensory
Valerie Legendre:inter- intervention or interactions that may need interventions or may
Valerie Legendre:play out in a different way for them than they would had they had that full
Valerie Legendre:time in utero to grow and develop.
Catherine:It, it, it's just incredible.
Catherine:It really is.
Catherine:We were out in Europe, and I was so pleased to know that of those countries
Catherine:extended leave for instances when a child is born with e- either prematurely or
Catherine:with some sort of condition that is going to require more special care at home.
Catherine:So Colorado, in United States, has added They call it maternity and
Catherine:bonding leave, which I, I love.
Catherine:, so they have 12 weeks for bonding with an additional 4 weeks for
Catherine:serious health conditions related to pregnancy or childbirth complications.
Catherine:And now this is still f- far behind Europe, but it's something, right?
Valerie Legendre:Yeah, and it, that's one of the things that we
Valerie Legendre:see with our families that's unique, right, is every, every family
Valerie Legendre:has to leave their baby behind.
Valerie Legendre:They don't get to take their baby home.
Valerie Legendre:And so in our state, obviously, we have the, the bigger cities clustered
Valerie Legendre:here, but then lots of rural towns.
Valerie Legendre:So there may be families that are having to stay outside of their community
Valerie Legendre:and stay in the Ronald McDonald House here to be close so that they
Valerie Legendre:can provide the care and learn these things, because the, the number one
Valerie Legendre:thing is bonding and holding and, and interacting and learning these things
Valerie Legendre:so that they can have the best outcomes.
Valerie Legendre:And so we definitely encourage that, but family members are having to
Valerie Legendre:be away from their home environment potentially if they live out of town.
Valerie Legendre:If people who live in town even, they have to schedule to come in, and if you
Valerie Legendre:have multiple children, you're having to figure that out with a spouse.
Valerie Legendre:So oftentimes even within married couples, the, the one is present and the
Valerie Legendre:other one is home holding down the fort.
Valerie Legendre:That's a divided process, which wouldn't necessarily happen if they
Valerie Legendre:were in their home environment.
Valerie Legendre:So, and then add in that dynamic of everyone figuring out how this
Valerie Legendre:plays out with their work, and every work is different in what
Valerie Legendre:they offer for families as leave.
Valerie Legendre:But it, it's definitely a juggle and a process, and every single family
Valerie Legendre:I've interacted with that has work thrown into that mix has to figure
Valerie Legendre:out when am I taking my time off?
Valerie Legendre:Am I gonna work while I'm still here so that I can have the
Valerie Legendre:extra time when I get home?
Valerie Legendre:Because we know we have that transition, and it's like having a newborn.
Valerie Legendre:You gotta, you gotta go through all those processes as a family.
Valerie Legendre:And so these courses, if you have a 22-weeker or somebody that's born that
Valerie Legendre:early and then they're there till that due date, that's a large chunk of time
Valerie Legendre:already taken away from the normal systems and, and the way family's working, and
Valerie Legendre:then that process then of going home.
Valerie Legendre:And one thing that is unique for me is that I'm not just an OT that does
Valerie Legendre:therapy with babies in the NICU, but I myself had a 28-week premature infant.
Valerie Legendre:My son was three and a half, and we spent three months in the NICU with my daughter.
Valerie Legendre:And I can attest to the stress of and the dynamics because
Valerie Legendre:we lived through that process.
Valerie Legendre:Not only have I seen families do it, we had to live through that process
Valerie Legendre:of dad being home with son and helping there and then me coming in.
Valerie Legendre:And the commute for us is 45 minutes.
Valerie Legendre:so just figuring out our day-to-day and learning how to do that for that duration.
Valerie Legendre:it definitely puts to light the personal aspects of it.
Valerie Legendre:I often tell families biggest thing to focus on when you get home is just pretend
Valerie Legendre:they're a newborn and bond as much as you can and try to get in routines because
Valerie Legendre:everybody has this huge readjustment.
Valerie Legendre:And it took a good year, I think, for us to really get in a good system and rhythm
Valerie Legendre:with our family, adjust to the trauma.
Valerie Legendre:There's a lot of trauma that happens both from mom's very traumatic
Valerie Legendre:birth oftentimes to the processes of parenting in a hospital environment.
Valerie Legendre:And it took us a good year, I feel like, for our family to finally take
Valerie Legendre:a breath of , okay, we got this.
Valerie Legendre:that's a long time that work doesn't account for, right?
Valerie Legendre:So it's awesome to see that there's states really focusing on the extra time.
Valerie Legendre:I love that they put bonding in there because when you go home, there is a lot
Valerie Legendre:of bonding and a lot of adjusting working through that trauma that you've had.
Valerie Legendre:I would say more is needed too.
Valerie Legendre:So yeah, good starts.
Valerie Legendre:I'm encouraged to see and I hope other states start to
Valerie Legendre:jump on the wagon for sure.
Catherine:You're, you're bringing hope, not just as an occupational therapist,
Catherine:but also you had your, your premature baby and you went through all of the motions,
Catherine:and you worked through it, and it, it, it brings hope, and it's inspirational.
Catherine:Your job is certainly needed, but it's also emotional because you're
Catherine:dealing with life, and it's the first part of life for these babies, and you
Catherine:are the one that is there every day.
Catherine:And that's really hard, I think, for a, a mother to realize is that
Catherine:she's not there, can't be there with baby, and you are thank you for
Catherine:all the work you're doing with the families as an occupational therapist.
Catherine:So is there anything else that you wanted to share before we
Catherine:get to your last inspiring words?
Valerie Legendre:No.
Valerie Legendre:Well, I think that maybe this would go into my last inspiring words.
Valerie Legendre:One of the things in working with moms and families in the NICU and working
Valerie Legendre:with extremely premature and sick babies, one of the, the most powerful
Valerie Legendre:things that I've seen and encouraged to see is just the power of touch.
Valerie Legendre:First touches, first holdings, the power of being able to wrap your
Valerie Legendre:hands around a baby that is, is in a painful procedure or that is just
Valerie Legendre:needing a minute how powerful that is and seeing how it, for a tiny little
Valerie Legendre:human being, that can be so comforting.
Valerie Legendre:I am in a position where I get to share that and teach families
Valerie Legendre:that, and then seeing the results that come of it is, is amazing.
Valerie Legendre:And so I guess for, for every mama or every person that's going in that that
Valerie Legendre:journey of a premature baby or a sick baby or a hospitalized baby, I mean,
Valerie Legendre:it even extends into older kiddos going to the hospital, is just not
Valerie Legendre:to forget the power of human touch.
Valerie Legendre:And one of the most joyful things that I can do is adapt, in my brain as the
Valerie Legendre:OT, adapt the environment in any humanly possible way to allow to support parents
Valerie Legendre:touching their children when they're in these moments, both for themselves and
Valerie Legendre:for their child, and the power of healing that that has for everyone involved.
Valerie Legendre:And so, I'm, I'm privileged.
Valerie Legendre:I, I love what I do.
Valerie Legendre:I, I, I'm passionate with what I'm doing, so never forget how
Valerie Legendre:powerful our touch as moms are to our, our children, young and old.
Catherine:Oh, I love that
Catherine:I think that's incredible.
Catherine:And Valerie, the power of touch for all ages is certainly an incredible piece
Catherine:that we can bond together with humanity.
Valerie Legendre:Thank
Catherine:And that's just what you're doing in the family unit.
Catherine:So Valerie LeGendre, thank you so much again for being here and sharing your
Catherine:work as an occupational therapist, and the love that you have in doing so.
Catherine:Thank you so much.
Catherine:To learn more about neonatal therapy, go to neonataltherapist.com.
Catherine:And to learn more about the power of touch, go to World Health Organization,
Catherine:and that website is who.int, and within the site, search skin to skin.
Catherine:And another website, Union of European Neonatal and Perinatal Societies,
Catherine:and that website is uenps.eu/parents.
Catherine:And this website brings more information to you regarding what happens now that I'm
Catherine:bringing my baby home, plus more research.
Catherine:And thanks for listening as we celebrate mothers around the
Catherine:world during the month of May.
Catherine:If you'd like to buy me a coffee to help fund the production
Catherine:of this podcast, here's how.
Catherine:Go to buymeacoffee.com/Yourpositiveimprint and any support you offer
Catherine:will be greatly valued.
Catherine:Thank you so much for your support and for listening to your positive imprint.
Catherine:And until next time, enjoy listening to over 200 episodes of your positive
Catherine:imprint, your positive imprint.
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