RCW, question for you about newborn/NICU

PixieCurlPixieCurl Registered Users Posts: 5,656
RCW, I know you have a lot of knowledge about pregnancy/birth/babies as well as a medical background in nursing, so I'd like to get your opinion on something.

As I posted, my sister just had her baby last Thursday. He was born at 35 weeks and was 5lb 9oz. He's been in the NICU since then. He was intubated his first night because of high CO2 levels, and the vent was taken out in the morning because his levels were better. He's still in the NICU now, and will be for a few more days at least. The reasons they're giving are (1) his body temp is low. When I was there today, it was 36.5'C, and I understand 37 would be normal. They've got little heel warmer thingies on him, and a warm outfit, plus a couple fleece blankets. (2) he's been fed through IV and has been working on breastfeeding since last night. He's having difficulty but has had a few successful nursing sessions. They don't want to take out the IV and release him until he's nursing better, especially since he's so small. (3) He's a bit jaundiced. He didn't look extremely jaundiced to me, just what's probably normal in most newborns.

Anyway, I feel like instead of separating the baby from my sister, these problems could all be helped with kangaroo care, having her wear him skin-to-skin with a blanket over both of them, frequent nursing attempts, etc. Right now she's in her recovery room and going to the NICU every few hours to see/change/nurse him. I can't even fathom being separated from my newborn like that. I've been keeping my mouth shut because she's not complaining about the circumstances, and though we disagree on a lot of parenting stuff she's mostly respectful of my choices (to my face at least) so I feel I owe her the same courtesy. But it is killing me to not put my two cents in. She's being released from the hospital tomorrow and they don't know how much longer the baby will have to be there. If it were me, I'd be so tempted to just check him out and bring him home and wear him and nurse him nonstop. But I'd also hate for my own distrust of doctors and desire to be with my baby to cloud my judgement when he really did need the medical care of the NICU (if it were me).

So what are your thoughts on the matter?
Faith, 3Aish redhead
Mama to two wild superheroes and a curly-headed baby boy :love5:
«1

Comments

  • ruralcurlsruralcurls Registered Users Posts: 2,574
    I know you asked for RCW's help, but I completely agree with you.
    My son was not much bigger, born at home, and he did great with constant nursing. He gained really nicely by doing that. I don't know too much about the other reasons, other than frequent bf would help with the jaundice, they are keeping him there, but saying he is so small is bs in my opinion.

    It must be so hard for you not to say anything.

    I hope your sister and nephew
    both feel better soon-what you want them to do would be good for both of them.
  • mrspoppersmrspoppers Registered Users Posts: 7,223 Curl Novice
    Pixie, even if you and RCW think the baby should go home, it's not up to you. Your sister and her husband should be making all decisions about their children without any input from the outside unless they ask for it. I know you love your sister and your heart's in the right place for wanting what's best for your nephew. I just think it's none of your business.
    When are women going to face the fact that they don’t know their own bodies as well as men who have heard things?

    Don Langrick
    Bonsai Culturist
  • M2LRM2LR Registered Users Posts: 8,630 Curl Connoisseur
    I just wanted to say that I understand how hard it is to want to say something about how others (esp. relatives) take care of their babies.

    My brother and SIL had their first in February and I can't tell you how many times I have had to bite my tongue.

    I agree with Mrs. P. I too know that your heart is in the right place...but I too think that you should just let them parent. Part of parenting is making your own decisions in matters like this.
    :rambo:
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    First of all, I intended to post this on P&P. I must have been pretty tired last night when I posted it here... maybe a mod can move it for me.

    Secondly, MrsP and M2LR, I definitely don't intend to voice my opinion. My husband and I have been discussing it a lot and what we would do in that situation, but unless she asks for my opinion I will not give it. And even if she does ask (which I doubt), I will only give a concise, honest answer, not a whole tirade about my beliefs. I definitely do respect that it's not my place to tell her what to do or to act judgemental toward her. Even though it's really hard to keep my mouth shut!

    rural, thanks for sharing your opinion/experience. I definitely know that keeping them together would do more to foster breastfeeding which would in term help with weight gain and the jaundice. I don't know about the body temp thing. My mom was criticizing the lactation consultant because she had my sister strip the baby down when she attempted nursing - which I know is standard advice if the baby is too drowsy to nurse - but I don't know how it would affect his temp. I would think that her body heat would help keep him warm if she held him skin to skin, then she could place a blanket over him.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • SystemSystem Posts: 39,060 Administrator
    Moved this for you, Pixie.
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    Thanks Suzen!
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • DarkAngelDarkAngel Registered Users Posts: 2,671 Curl Neophyte
    I know it's hard but try to cut your sister a bit of slack. You are definitely right that kangaroo care and skin to skin contact would be best for baby. I would be surprised if the NICU staff wasn't recommending that. However, don't underestimate the level of pain or just all around disorientation she may be experiencing. I was in too much pain when Alexander was born to spend as much time there as many people may feel I should have. I also felt a serious disconnect those first few days as nothing had gone the way I'd planned or even imagined it could go.

    As for the stripping down to nurse, that was recommended for me with Alexander but not Sebastian and both had issues with body temp. I guess it varies by LC.

    I hope he's home soon. We got maybe 12 hours notice before we brought Alexander home so your new nephew may be home any day now.
    image.php?type=2&o=5&c=1&date=2009-10-07&babyname=Sebastian

    "Be who you are and say what you feel, because those who mind don't matter and those who matter don't mind." -- Theodor Seuss Geisel
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    DarkAngel, I do keep reminding myself that she is recovering from surgery, and cutting her some slack accordingly. I do know that she's taking advantage of all the drugs they're offering her (again, not what I would do, but...) so whenever I ask how she's feeling, she says not too bad. But I do know that she's still experiencing some discomfort.

    I did get her a Sleepy Wrap (like a Moby, but slightly different) as a baby gift per her request - ever since she's seen me wrapping Abram she's wanted to try and I asked her flat-out if she wanted to try one of mine first or if she wanted me to buy her one of her own as a baby gift. That should be arriving in the mail today so maybe when I give it to her, I can casually and briefly mention the benefits of kangaroo care. Or even print out an article about it and pretend it's new information ("Wow! I just read that kangaroo care can be really beneficial for preemies. Who knew?!").

    I too hope the baby can come home soon. I don't even know how she's supposed to or planning to attempt breastfeeding after she's been discharged. I'm sure she'll be there frequently during the day, but what is she supposed to do at night? I know she's been pumping, so maybe the nurses will feed him her milk at night, and she will pump at home? If it were me, I'd sleep in the gosh darn chair beside his bassinet in the NICU, but again I have to remember that she's not me and that she's recovering from surgery.

    And before anyone asks, I'm not pushing my beliefs about breastfeeding on her. She breastfed my older nephew for a year (though she did supplement a little when she went back to work PT and couldn't pump enough to meet his needs) so it's very important to her too. She's not as die-hard about it as I am (few people are LOL), but it is important to her.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • M2LRM2LR Registered Users Posts: 8,630 Curl Connoisseur
    I guess I am confused on what is bothering you about the situation, the way SHE is handling it, or the way the hospital wants to keep him?

    Did she have a c-section with her first baby?
    :rambo:
  • RedCatWavesRedCatWaves Registered Users Posts: 31,259 Curl Connoisseur
    No, I would not insist on taking a NICU baby home early. The OB industry is dumb in many ways, but they don't usually keep babies in an expensive NICU if they don't need to be there. 35 weeks is significantly early, despite his 5.5 lb size.

    It sucks, and the separation will increase the risk of breastfeeding failure quite a bit, but until Jacob can maintain his temp and demonstrate an ability to nurse and breathe at the same time, he'll probably need to stay in NICU. Hopefully he'll come home soon. His size is a good indicator that that he won't have to stay long.

    It's really, really difficult for a mom to have both a c-sec and a sick baby. C-sec hurts. A lot. And getting to the nursery for every feeding is difficult, especially after discharge. I know I wasn't capable of going back to the hospital the first few days after discharge to see my 1st baby, who was still in the NICU. I was just too ill myself. The best I could do was call several times a day and ask how he was. I could not physically get there. It killed me inside too. And, yes, I failed at breastfeeding him.
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    M2LR wrote: »
    I guess I am confused on what is bothering you about the situation, the way SHE is handling it, or the way the hospital wants to keep him?

    Both, but I admit that I am not well-educated about newborn health and NICU's so I didn't know if the hospital wanting to keep him was justified or not. I know RCW tends to be both skeptical and knowledgeable, which is why I asked her opinion.
    M2LR wrote: »
    Did she have a c-section with her first baby?

    Yes, he was breech, and also born at 35 weeks because she went into labor on her own that early.


    RCW, I appreciate your response, thanks for sharing.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • curly_keltiecurly_keltie Registered Users Posts: 791
    PixieCurl wrote: »
    I do know that she's taking advantage of all the drugs they're offering her (again, not what I would do, but...) so whenever I ask how she's feeling, she says not too bad. But I do know that she's still experiencing some discomfort.

    As someone who's had a c-section, I do know that managing my pain with medication allowed me to focus on caring and establishing a succesful bf'ing relationship...instead of the pain I felt with every move.
    Long, blonde, 3a/mostly b hair.

    78Da.jpg78Dam6.png
  • CGNYCCGNYC Registered Users Posts: 4,938 Curl Connoisseur
    I had a C section and an early baby in NICU.

    I say this with all kindness, you need to just stay out of it. Don't look for cracks in the conversation to offer your opinion, just let it go and back off.
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    CGNYC wrote: »
    I say this with all kindness, you need to just stay out of it. Don't look for cracks in the conversation to offer your opinion, just let it go and back off.

    You're right. I know I need to keep my two cents to myself. I will give her the wrap as a gift because she asked for it, but I won't mention anything else when I do.

    If anything, I think posting about it here is just helping me get it off my chest.

    ETA: And for an update, it looks like Jacob will likely be released tomorrow. As of yesterday I think the main reason for keeping him was the jaundice, and they had him under the bili lights.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • iris427iris427 Registered Users Posts: 6,002
    Pixie, I say this with kindness because I like you a lot and I know your heart is in the right place. You've had two healthy babies born vaginally and you are very blessed. But you just don't know what it's like to have a cesarean and you don't know what it's like to have a NICU baby.

    Please try to get out of the thought patten "I wouldn't take so many meds after a cesarean" or "I would sleep in a chair in the NICU." Because those thoughts are judging your sister, who is surely doing the best she can in a hard situation. Honestly, you don't know what you would do in those situations until you have been there.

    I can tell you as a mom who had a c-section that taking every pill they offered me was the only way I could take care of my baby. Otherwise my entire body was wracked with pain. The one time I forgot to take my pain meds on time (my first day home), I ended up doubled over in pain barely able to move. But on my meds, I felt surprisingly ok. And as someone who had a c/s, I cannot imagine trying to sleep in a chair in a hospital after having major surgery. Seriously. That does not sound like a realistic option for her at this time. A new mom, and especially a new mom who had a c/s and has a sick baby, needs to sleep as much as she can and take care of herself too, and that is not going to be facilitated by camping out in the NICU.

    I know that hospitals can be frustrating places. I shadowed some lactation consultants recently and I saw how hard it is for them to promote breastfeeding in the NICU--they actually had doctors actively discouraging moms from nursing their NICU babies. And this was in a "Baby Friendly Hospital," so I can just imagine how the non-baby friendly ones are! I can certainly understand your frustration.

    Be there for her, support her and she will always remember your kindness in a hard time. Best wishes to your sister and nephew.
    3027585431_55b6195e50_s.jpg3028374752_0df4d81a1b_s.jpg3028422696_8dcef38baa_s.jpg
    TickerTicker.aspx?&TT=bdy&TT1=bdy&CL=29&CT=&CG=F&O=m_nestbirds&T=t_b14&D=20080913&M1=&D1=2009&T2=&T1=Baby+Iris&CC=0&CO=&step=5&radio=A
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    I know that you are right iris. My experiences have been completely different and I can only imagine what it must be like for her - I have absolutely no way to empathize but I still must sympathize. Maybe it bothers me that she doesn't seem bothered by it? She's in good spirits and doesn't seem to mind being separated from her baby, but maybe she's just trying to make the best of the situation and be joyful of his birth instead of acting gloomy.

    I will reiterate that she, lately and to my face at least, has been very respectful of my parenting choices as they differ from hers, so I of course owe her and show her the same courtesy.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • CocoaCoilyCocoaCoily Registered Users Posts: 2,648 Curl Neophyte
    My daughter was in the NICU for 63 days. It was the worst roller coaster ride of my life. I had to stay in the hospital for about a week after she was born, due to complications and my severe blood loss. I could not even go to see her the day she was born, because I was so weak.

    Late into the second day, when I finally managed the strength to have a nurse put me in a wheelchair to visit her, and saw her for the first time, all hooked up, I started to cry. A NICU nurse came over, and told me gently that I needed to be strong for my daughter, and that my sad feelings would be felt by her. I needed to put on a brave front. She had a very good point.

    One must keep a positive attitude. I minded terribly that I was separated from my baby. Not to mention the guilt I felt. But, being in a constant funk was not going to help the situation at all. Plus, being in a funk would only exacerbate whatever sad feelings there were inside of me. So, I stayed as positive as I could, and put out good vibes for my daughter's sake.

    If someone had said anything like what you want to say to your sister, I think I would have put that person out of my life for being insensitive, and for wanting me to, in essence, jeopardize my baby's well being. I don't say this with mean spirit.

  • PixieCurlPixieCurl Registered Users Posts: 5,656
    CocoaCoily, I'm so sorry you had such a rough time at the beginning of your daughter's life.

    I hope you and everyone else understand that I do not actually plan to or even want to say any of these things toward her. I really am just posting on here to get it off my chest, and I've acknowledged that I can't possibly understand how she feels.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • CGNYCCGNYC Registered Users Posts: 4,938 Curl Connoisseur
    Maybe it bothers me that she doesn't seem bothered by it? She's in good spirits and doesn't seem to mind being separated from her baby, but maybe she's just trying to make the best of the situation and be joyful of his birth instead of acting gloomy.

    This was how I managed after my daughter was born. She was only in NICU for four days, but it was four LONG days. As the issues started piling up, I had one good breakdown when no one else was there, and then I put it away. I felt that it would be worse to sit around and cry and dwell on things I couldn't control, and better for me to just focus on the fact that my daughter was here and she was (overall) healthy and we'd all be going home soon.

    So I did not sit around and cry and freak out when people came to visit, I put on my happy face and refused to listen to any negative crap from anyone and we got through it. I don't want to look back on my daughter's birth as "less than" or unhappy because things didn't go according to my plans and I didn't want to spend the first few days of her life being unhappy. It was hard and I had some low moments, but I kept those to myself.
  • CocoaCoilyCocoaCoily Registered Users Posts: 2,648 Curl Neophyte
    I know you're not going to say anything, and that's good. It's also good that you're trying to get it off of your chest, but I think it's kind of important for you to also understand that what you're feeling is not really right. Maybe this is hitting close to home for me, but it's good to have benefit of the perspective of someone whose birthing experience was very different from your own.

  • RedCatWavesRedCatWaves Registered Users Posts: 31,259 Curl Connoisseur
    PixieCurl wrote: »
    Maybe it bothers me that she doesn't seem bothered by it? She's in good spirits and doesn't seem to mind being separated from her baby, but maybe she's just trying to make the best of the situation and be joyful of his birth instead of acting gloomy.



    I think it's important to note that your sister is a nurse, and a high-tech nurse at that. She's probably very comfortable with the medical model of care, probably moreso than a more-natural model.

    I didn't see my 1st baby til he was 4 days old, because he was transferred to another hospital directly after birth, before I woke up from general anesthesia. No one really knew how much I was suffering during those days, because I seemed like any other excited new mother. The separation from my first baby is actually what led me to homebirth though. So, it's not always readily apparent how someone is truly feeling.
  • WileE-DeadWileE-Dead Banned Banned Users Posts: 24,963 Curl Neophyte
    CocoaCoily wrote: »
    I know you're not going to say anything, and that's good. It's also good that you're trying to get it off of your chest, but I think it's kind of important for you to also understand that what you're feeling is not really right. Maybe this is hitting close to home for me, but it's good to have benefit of the perspective of someone whose birthing experience was very different from your own.
    ita..
    PC...I am going to say something that won't be favored, tho I think you need to think about how you feel the need to have control all the time...
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    PC...I am going to say something that won't be favored, tho I think you need to think about how you feel the need to have control all the time...

    How is posting here that I wouldn't necessarily do the same thing as my sister trying to have control over her? I said in my FIRST POST that I wasn't putting my two cents in with her.

    CC makes a great point. I can never say what I would do in her situation because I haven't been there so I don't know what it's like. As I said before, I have no way to empathize so I need to try harder to sympathize.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • CGNYCCGNYC Registered Users Posts: 4,938 Curl Connoisseur
    I don't think it's about controlling your sister, but control in general. You seem to need a lot of it, or at the very least you seem to have the impression that if you plan everything just right then you can control everything. Like - I wouldn't have done this or I would have done that so this situation wouldn't have happened to me. It can be a huge blow when you do everything just right and things still don't go the way you plan.

    You know I like so I'm not saying this to be mean to you, but you also know this control thing comes up a lot. It might be worth considering. You seem very open to examining your own motivations and reactions, so I don't think Wile is being disrespectful in pointing this out.
  • M2LRM2LR Registered Users Posts: 8,630 Curl Connoisseur
    I am wondering if it would help to look at it in a different light than having to be sympathetic or empathetic to your sister. Either one will be VERY hard to understand, mainly for the reasons that others have mentioned.

    I didn't know that your sister is a nurse, so she is probably extremely trusting of what is going on, and honestly, I would be too. If a doctor told me my baby needed to be in the NICU I would probably let him/her stay. I couldn't imagine insisting on taking them home to baby wear and nurse and then having something horrid happen. Baby wearing, and nursing, and AP is great, but there are times that medical intervention needs to be there.

    I know you said in your first post that you weren't going to say anything to her, but a few posts down, you were trying to figure out how to make a comment when you give her the wrap.

    I think that it would show her a LOT more if you just didn't say anything at all, give her the wrap and let her go from there. She might seem like she's doing okay and stuff, but when it's just her at home/hospital, or when it's just her and her husband, I am betting that she is not just "okay" and the little baby is the ONLY thing on her mind.
    :rambo:
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    I obviously misunderstood Wile E, I did think she meant I was trying to control my sister but I see what you are saying CGNYC. I do try to have control over situations in my own life (and my kids). Ever since Solomon's birth didn't go how I wanted it to, and I felt powerless, I've made a real effort to plan and have control over other issues regarding their health, my health, pregnancy/birth, etc. I'd be embarassed to admit all the detailed questions I asked my midwife during my pregnancy with Abram, so that I could try to plan for every possible situation. I guess for me, and what I learned with Solomon's birth, was that I can live with owning my decisions under adverse circumstances if I feel I'm educated about my choices and not being bullied into blindly doing as someone else says. I know RCW has a similar outlook, which is why I posted this thread in the first place.

    All that said, I really do respect a lot of you sharing your experiences and telling me how my attitude might not be right. I initially started this thread to sort of vent about my sister, but many of you have helped me realize that I really can't relate and that I should have more compassion.

    And as RCW said, my sister is a nurse as is my mom, so both of them are definitely more comfortable with a medical model of care than a natural one.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • RedCatWavesRedCatWaves Registered Users Posts: 31,259 Curl Connoisseur
    The time to control was before the c-section happened. Personally, unless I was about to bleed to death, I wouldn't have allowed a c-sec at 35 weeks just because of a few contractions or a little dilation. I'd have held on til the bitter end...and probably tried a vaginal birth to boot (provided the previa wasn't complete). But the baby is here now...premature and having problems. There's not much to control. Everything is out of sister's control. Once you're in "the system", the system is in control.
  • PixieCurlPixieCurl Registered Users Posts: 5,656
    The time to control was before the c-section happened. Personally, unless I was about to bleed to death, I wouldn't have allowed a c-sec at 35 weeks just because of a few contractions or a little dilation. I'd have held on til the bitter end...and probably tried a vaginal birth to boot (provided the previa wasn't complete). But the baby is here now...premature and having problems. There's not much to control. Everything is out of sister's control. Once you're in "the system", the system is in control.

    It was a complete previa, and she had experienced some significant-ish bleeding the week before. Plus she'd been having contractions for quite a while (on and off for months it felt like) and by this time they were every 3 minutes... so pretty much, she was in labor. She went into labor naturally at 35 weeks with her older son too, who was also a C-section because he was breech.
    Faith, 3Aish redhead
    Mama to two wild superheroes and a curly-headed baby boy :love5:
  • RedCatWavesRedCatWaves Registered Users Posts: 31,259 Curl Connoisseur
    PixieCurl wrote: »
    The time to control was before the c-section happened. Personally, unless I was about to bleed to death, I wouldn't have allowed a c-sec at 35 weeks just because of a few contractions or a little dilation. I'd have held on til the bitter end...and probably tried a vaginal birth to boot (provided the previa wasn't complete). But the baby is here now...premature and having problems. There's not much to control. Everything is out of sister's control. Once you're in "the system", the system is in control.

    It was a complete previa, and she had experienced some significant-ish bleeding the week before. Plus she'd been having contractions for quite a while (on and off for months it felt like) and by this time they were every 3 minutes... so pretty much, she was in labor. She went into labor naturally at 35 weeks with her older son too, who was also a C-section because he was breech.



    The loss-of-control goes quite far back then. The first c-sec probably caused (or at least heavily contributed to) the placenta previa (one of the reasons I call c-section the-gift-that-keeps-on-giving). She had no control then. She has none now. Sometimes the cards are just stacked that way. Choosing to be happy anyway and just flow along waiting for control to return is probably the best way to go.
  • iris427iris427 Registered Users Posts: 6,002
    PixieCurl wrote: »
    I know that you are right iris. My experiences have been completely different and I can only imagine what it must be like for her - I have absolutely no way to empathize but I still must sympathize. Maybe it bothers me that she doesn't seem bothered by it? She's in good spirits and doesn't seem to mind being separated from her baby, but maybe she's just trying to make the best of the situation and be joyful of his birth instead of acting gloomy.

    I will reiterate that she, lately and to my face at least, has been very respectful of my parenting choices as they differ from hers, so I of course owe her and show her the same courtesy.

    Maybe I can give you some perspective? I had an awful birth (although thankfully my daughter was healthy and did not need to be in the NICU). But it didn't hit me how hard it was for me until much later. In the days and weeks following my c/s, I was like "oh well, at least we are healthy. Everything is ok." It wasn't until months later that I realized how not ok I was.

    When a new mom has a tough delivery and/or sick baby, it's a common defense mechanism to put on a happy face and not deal with her own emotions. She needs to focus on caring for her baby and recovering from childbirth and for a lot of moms, they just can't handle processing intense emotions on top of everything else. They can't sit around and cry all day because they have to keep it together for their baby and their family. Once some time has gone by, she can then process them at her own pace.

    So if she doesn't seem upset, it may be that she is coping with things in her own way.
    3027585431_55b6195e50_s.jpg3028374752_0df4d81a1b_s.jpg3028422696_8dcef38baa_s.jpg
    TickerTicker.aspx?&TT=bdy&TT1=bdy&CL=29&CT=&CG=F&O=m_nestbirds&T=t_b14&D=20080913&M1=&D1=2009&T2=&T1=Baby+Iris&CC=0&CO=&step=5&radio=A

Leave a Comment

BoldItalicStrikethroughOrdered listUnordered list
Emoji
Image
Align leftAlign centerAlign rightToggle HTML viewToggle full pageToggle lights
Drop image/file