From Care Provider to Patient: My Experiences in the NICU

By April Farmer, CRNP, NNP-BC

The author in her natural habitat.

As far back as I can remember, I’ve wanted to be a nurse—I had no intentions of doing anything else! I always thought nursing was the field for me because I could care for others and be a teacher and counselor, all at the same time. I originally thought I was going to work in the emergency department; I had no idea that the NICU existed. One day, our class took a tour of one of the largest hospitals in Alabama, and one of the units we visited was the NICU. I was immediately drawn to these tiny babies.

After that tour, I decided to do my preceptorship in the NICU, and it was then that I fell in love with neonatal nursing. I was very fortunate after nursing school to be offered a position in the NICU. I could not imagine working in any other area of nursing—and that’s where I’ve been since January 2004. I initially worked as a bedside nurse and then decided to further my education and become a neonatal nurse practitioner (NNP), a role I’ve had for the past 5 years of my career.

What I love about the NICU is that premature infants are fighters. I see them defy the odds every day. If you don’t believe in miracles, come visit the NICU. I also love that from the beginning, each one of these little babies has their own personality. They cannot tell you when something is wrong; you have to depend on your assessment skills and their cues to figure out what they need. It’s such a joy to see these infants grow and thrive. What I love most, though, is watching the parents get more and more comfortable caring for their child.

I’ve met so many wonderful families during my years in the NICU. They entrust you with their most precious possession, their child. It’s hard not to bond or connect with these people who spend weeks and months in the unit. When I’d been a NICU nurse for about a year, there was a baby I cared for who was born at 23 weeks and spent months in our unit. As I cared for this infant on a regular basis, I really bonded with the family. I remember many times over the months thinking that this patient was not going to survive. This family had the strongest faith I’ve ever seen, and eventually they did go home with their baby. Years later, they brought that child up to the NICU to see me. I was shocked that I touched their lives that much! They recalled specific things I had said or did, and it was one of those moments when I realized that my job makes a difference. I don’t do this job for recognition, but it’s nice to know I made such an impact.

Shortly before Rilee’s birth.

After spending so much of my time around other people’s babies, I was excited when I found out my husband and I would be welcoming our own child into the world. I had no complications during my pregnancy, and my only risk factor was advanced maternal age, as I would be 35 years when my son was due to be born. However, Rilee had different plans—I went into labor at 29 weeks and 4 days, and just like that, I went from NICU nurse to the mother of one of those tiny, vulnerable babies.

My labor happened so quickly that there wasn’t much time to process it. I didn’t sleep well the night before. I just could not get comfortable but assumed it was normal. I was scheduled to work, so I decided to go ahead and get up early since I wasn’t sleeping anyway. While in the shower, I began to hurt and feel nauseated. Even then, I still didn’t process that I might be in labor. I figured if I was still hurting when I got to work, I would go to Labor & Delivery and get checked out.

Rilee made his appearance more than 10 weeks early.

While trying to get dressed and ready for work, the pain was worsening. I began to vomit and feel the urge to go to the bathroom. That’s when it finally hit me that I might be in labor. I woke my husband up, and he drove us as fast as possible the 75 miles to the hospital. About halfway there, my water broke in the car. The contractions were coming every 2 minutes, and I was focusing on trying to keep my legs crossed because I could feel the baby’s head. When we arrived at the hospital at 6:15 a.m., I was completely dilated. There was no time for any medications or an epidural; I pushed twice, and Rilee was born at 6:30 a.m. I was in complete shock, and it took a little while for me to really process the fact that I had given birth more than 10 weeks ahead of schedule.

Having worked in the NICU for so long, I had some idea of what would happen next. I knew he would require oxygen and have apnea/bradycardia episodes, and I was prepared for him to not be a great PO feeder. What I was not ready for was the pain I felt as he struggled to breathe and had episodes. As a nurse, I knew it was totally normal, but as a mom, I was disappointed every time he took a step back and that he was not progressing at the pace I wanted him to.

April and husband Thomas visiting with their son, Rilee.

Working in the NICU may have prepared me for what to expect medically, but it did not prepare me for what I was going to experience emotionally. I had no idea the guilt I would have for not carrying Rilee to term. I felt my body had failed me, and I had failed my child. I mourned those last 2.5 months I missed out on and my lost chance at a full-term pregnancy. It may sound silly, but I felt cheated out of normal experiences like maternity pictures or being pregnant at my two wonderful baby showers.

One of the hardest things I had to do was to leave my baby. When I was discharged and had to leave Rilee for the first time, I sobbed the entire ride home. It’s just not natural to leave your child. I had envisioned giving birth and leaving the hospital with my baby in my arms. It’s also difficult letting others care for your child. As an NNP, I’m used to making the decisions and caring for the patient. It’s hard to just sit back and feel so helpless. I felt like I had to put on a brave face because I worked in the NICU, but there were days I felt like I was falling apart. I was stressed, exhausted, and anxious.

I went back to work when Rilee was 9 days old. That may sound quick, but I wanted to save my maternity leave for when he was discharged. My hospital was great, and I was allowed to come back even though Rilee was a patient in my unit. I did not care for, round or make decisions on my son, but it was nice to be able to go back to work and visit him on my breaks and during my downtime.

April checking in on Rilee’s progress in the NICU.

My sweet coworkers were wonderful to Rilee, as well as to my husband and me. We both felt like my son was given extra-special care and attention. The nurses celebrated his accomplishments and milestones with us; they also let me cry and vent to them. A few of my coworkers have had premature infants, and they understood exactly how I was feeling.

One particular experience with my nurses will always stick with me: When Rilee was about 3 or 4 weeks old, the night shift nurse asked me if I wanted to help bathe him. I know this may sound silly to some, but I appreciated it so much. Working in the NICU, I have bathed many babies—but this time, I got to bathe MY baby. This little thing really meant a lot to me.

Knowing what to expect as a NICU nurse was a blessing and a curse. I knew Rilee was doing well for 29 weeks, but I also knew all of the things that could go wrong. I was constantly waiting on something bad to happen. I had a hard time enjoying my baby and how well he was doing for the fear of the “what ifs.” I remember saying multiple times during his NICU course that I couldn’t believe how well he was doing, but that I didn’t trust him. I also got anxiety when it was time for a test, such as a head or cardiac ultrasound. When all was said and done, Rilee was in the NICU for 50 days. He was discharged home at 36 weeks and 5 days.

Finally going home!

Being a NICU mom has definitely made me change my way of thinking when it comes to talking to parents. I know each and every mother’s experience is different, but I feel like I can empathize now. Sometimes when mothers are having a hard time or feel like no one understands them or their situation, I just sit down and talk to them. I let them vent and tell them I understand. My experience may be different, but I do understand. Sometimes I do share my experience with a mother if I feel led to or if I think it will help.

Skin-to-skin care is good for baby and mommy.

I’m also quick to make sure mothers are holding their babies or doing skin-to-skin as soon as medically possible. I felt like this helped me to bond with Rilee and with my breast milk production. I also encourage moms to start pumping right away. I think pumping made me feel like I was actually doing something for my son at a time when I was virtually helpless—I was unable to care for him, so making milk was my contribution. It was the one thing that only I could do for him.

To women who find themselves in the NICU, I would say to take it one day at a time. Your baby will have good and bad days—you will have good and bad days. It truly is a roller coaster ride. Lean on friends and family for support. Find a NICU support group, which is great for parents to bond and share their experiences with one another. Don’t be afraid to ask questions or voice your concerns. You are the voice for your child; you are their advocate.

For fellow NICU nurses: Talk to the parents of these tiny, vulnerable babies. Listen to their concerns, and ask them how they’re doing. Sometimes they just need someone to talk to. Also, get them involved wherever possible. Encourage touching and holding. Ask them if they would like to help you take a temperature or change a diaper. It’s their baby, and they would like to feel like they are contributing. I will always remember when I got to bathe my son while he was in the NICU. Small gestures like this will mean more than you will ever know.


April Farmer, CRNP, NNP-BC, is a neonatal nurse practitioner in Birmingham, AL.

Lessening the Risk of Birth Trauma

By Karin Beschen, LMHC

 “I was at a routine dental office visit a few weeks after my daughter was born. I remember being reclined in the chair, the bright overhead light and the scent of latex.  Images of surgical masks whipped through my mind.  Fear rushed through my body and I shook uncontrollably.  My body felt hollow and numb but also heavy and out of control.  In that moment I truly believed I was having another emergency c-section.”

This quote is from a woman who experienced a traumatic birth.  She is the mother of a beautiful baby and has had many moments of joy and connection, but also times of panic and fear.  “Mini movies” of her daughter’s birth play in her mind throughout the day.  She deleted the photos of her daughter in the NICU and she wants to disappear when her friends talk about pregnancy.  The birth didn’t end when her baby was born; it followed her from the hospital and it has interfered with many aspects of her life.

Research reveals that between 33-45% of women perceive their births to be traumatic. (Beck, 2013).  Birth trauma is defined as “an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother or her infant.  The birthing woman experiences intense fear, helplessness, loss of control and horror.”  (Beck, 2004a, p. 28).

Approximately 9% of women experience postpartum post-traumatic stress disorder (PTSD) following childbirth. Most often, this illness is caused by a real or perceived trauma during delivery or postpartum. These traumas could include:

  • Prolapsed cord
  • Unplanned cesarean
  • Use of vacuum extractor or forceps to deliver the baby
  • Baby going to NICU
  • Feelings of powerlessness, poor communication and/or lack of support and reassurance during the delivery
  • Women who have experienced previous trauma, such as rape or sexual abuse
  • Women who have experienced a severe complication or injury related to pregnancy or childbirth, such as severe postpartum hemorrhage, unexpected hysterectomy, severe preeclampsia/eclampsia, perineal trauma (3rd or 4th degree tear), or cardiac disease

My therapy work with mothers is typically after a traumatic birth.  The more I learn about the mother’s labor and birth experience, the more I can understand what care and education could have better supported her during  birth.

The “3 E’s” – explain, encourage and empathize – can be a useful framework for obstetrical staff in lessening the risk of a traumatic birth.  

Explain  

When explaining a process, options or a procedure, always include the woman in the discussion of her own care.  There is a distinct difference in hearing a discussion and being a part of one.  If plans change, explain what is happening and what is needed to correct the situation.

Encourage

The connection a mother has with those caring for her during childbirth is deep — you are present during one of the most emotional, unpredictable times in her life.  Encouragement is empowering and can offer the mother a sense of control.  Encourage questions.   If plans change, discuss possible alternatives.   Using “we” in conversations shows alignment and rallying together.

Empathize 

Women in labor yearn for companionship, support and empathy.

Phrases such as “I know,”  “I’m here,” and “Yes” are phrases that connect staff with a woman’s experience when she feels pain, fear, disappointment or frustration.

I’ve heard many birth stories over the years; devastating stories of physical compromise, intense fear and loss of the baby’s life.  How the mother is cared for, is what she remembers.  The tone of your voice.  The gentleness.  The validation of feelings.  One of my clients was unaware she was being rushed for an emergency cesarean.  She said in all of the chaos and in a knee-chest position, she extended her arm and a nurse held her hand.  Beauty within terror.   It was a simple gesture and it has been the most powerful, healing memory for her.   Even in the midst of an emergency, someone saw her need.  Someone saw her.

Obstetric staff has great influence on how a mother remembers her birth experience.  Expressing empathy and explaining and encouraging a laboring and postpartum mom can influence her health and well-being.  New mothers who receive the “3 Es” can better transition to home, experience less anxiety, have more positive feelings about themselves and improved bonding with their babies.


Karin Beschen is a Licensed Mental Health Counselor specializing in reproductive and maternal mental health.  She also serves as a volunteer co-coordinator for Iowa for Postpartum Support International.

 

 

Additional Resources

Postpartum Support International 

PaTTCh (Prevention and Treatment of Traumatic Birth)

Improving Birth

References

Beck, C. T. (2004a). Birth trauma: In the eye of the beholder. Nursing Research 53(1), 28-35.

Beck, C. T., Driscoll, J.W., & Watson, S. (2013). Traumatic Childbirth New York, NY: Routledge.

 

 

 

Why Every Baby Deserves Optimal Care In The NICU

by, Tracy Whitman, RN

Premature babies depend on us as nurses and parents to be their advocates, their protectors, and most importantly their voices.  Their development in the NICU should mimic as closely as possible the uterine environment.  As new parents of NICU babies, it is often hard to understand this concept, and that is when the NICU nurse is your best resource for education about your new baby.  Continue reading

Auditory, Tactile, Visual & Vestibular Intervention to Reduce NICU Stress

by, Rosemary C. White-Traut, PhD, RN, FAAN

Having your new baby spend time in the Neonatal Intensive Care Unit (NICU) can be extremely stressful for both you and your baby. The bright lights, the random nature of nonhuman sounds such as beeps or monitors, and medical procedures can all create an uneasy or stressful environment.

This is concerning because stress can influence your baby’s brain development and how parents  interact with their babies. However, there are ways to help reduce the long-term effect of these stressors.

There are several things you can do as parents to help reduce NICU environmental stressors. Ask your nurse for help with these suggestions. Continue reading

Our Nurse Changed Our Lives

Jessica_Familyby, Jessica Grenon

When I think back to the birth of my second child earlier this year, tears almost instantly begin to fill my eyes.

Unlike the birth of my first child three years prior, this isn’t because I am overjoyed by thoughts of holding my baby against my chest for the first time while I stare in awe at the life my husband and I created, a life that I grew in my own body and delivered into the world after many, many hours of hard labor. Instead my eyes fill with tears because I think of my labor and delivery nurse and how I believe her actions on that day affected the trajectory of my life, my son’s life, and the future of our family.

I am not a nurse, I don’t even work in the medical industry, but for the past nine years come June my work has brought me to the annual AWHONN convention, where I support the online system used by those submitting proposals and assist presenters’ presentations. Through this work I have read hundreds of abstracts and watched dozens of presentations on standard topics such as home births and skin to skin care for newborns, to more memorable subject matters like how to care for a vaginal piercing during a delivery.

My work with AWHONN does by no means make me an expert in the field of labor and delivery, but on January 30th of this year, I had gained enough knowledge from working with AWHONN to know what the possible outcomes could be when something suddenly went wrong during the birth of my son.

After 13 hours of laboring in the hospital, the time had finally come to begin pushing. Not yet knowing the gender of my child, I felt extra encouragement to push as hard so I could finally meet my baby. It took only 21 minutes of pushing to hear the words, “only one more push, Jessica, and you will be able to hold your baby!”, however, that was quickly followed by a sudden shout to stop pushing.

Stop pushing, but why? I looked down and between my legs I could see the head of my baby, turned toward my inner right thigh; he was silent and lifeless. Right away I knew that it was shoulder dystocia, and like any mother, my mind went to straight to thinking about the worst case scenarios. Was my baby getting oxygen, would he have brain damage? Is his shoulder going to be broken? I don’t care if he has broken bones, bones heal, just make sure he can breathe! Just last June at AWHONN a presenter and I had a conversation about shoulder dystocia, what was it that she said the other outcomes could be?

The next few minutes were all a blur me screaming at the doctor to help my baby, my husband kissing my head and doing the best he could to stay strong for the two of us, the student midwife attending her first delivery still holding onto my left leg waiting for someone to give her instructions and then there was a voice that I will never forget. Then the firm voice of my labor and delivery nurse as she turned to the doctor and said, “Doctor. Would you like me to call for another set of hands?” I got the sense that she wasn’t asking for permission, but rather she was politely informing the doctor of her intent to ask for assistance because she knew it was needed.

The doctor nodded as my nurse instantly took one side step closer to my head, she looked me straight in the eyes and smiled as she pushed the call button for the nurse’s station and requested another attending physician join us in my delivery room. A moment later the door swung open and the already crowded room began to fill with more people. In an instant, my nurse and another doctor were in the delivery bed with me, pushing on my low abdomen , doing all they could to change the position of my baby.

In this chaotic scene I once again heard that firm voice calmly say, “Doctor. Would you like me to call in a NICU team?”. The doctor nodded yes and soon a NICU team stormed into the room to wait for my son to be born to take over his care.

At the end of this ordeal, I was blessed with a perfectly healthy child; not one bruise on his body, no torn muscles, no broken bones, and no lack of oxygen to his brain. He did stay in the NICU for two days to be supervised for a potential infection, but otherwise all 10lbs, 5ozs of him was unscathed during his traumatic birth .

It may have been my doctor’s hands that brought my son into the world, but it was my nurse’s voice that I credit for my son’s health and our future without the need for further medical treatment.

Would my son have been fine if he were stuck during the birthing process for another couple of minutes? I don’t know. Fortunately because my labor and delivery nurse spoke up during a time of crisis, I don’t have to find out.

JessicaJessica L. Grenon is the Director of Continuing Education Services at The Conference Exchange, where she has worked with AWHONN since 2007. She, her husband, and their two young children enjoy traveling and spending time with their extended family, especially with her twelve nieces and nephews.

 


Resources on Shoulder Dystocia

Definition: Shoulder Dystocia is the impaction of the fetal anterior or posterior shoulder behind the material pubic symphysis resulting in delay in a cephalic vaginal delivery. This creates a high-risk intrapartum complication affecting both mother and baby.

For Parents: Health providers can’t always predict or prevent shoulder dystocia, but there are some risk factors you can learn about.

For Nurses: AWHONN has a Shoulder Dystocia online product to help prepare clinicians for this level of critical care event.

Tools for Survival as a New Nurse in the NICU

By Lori Boggan, RN

It has been an amazing eleven year journey working as a neonatal nurse. The journey has taken me across the United States and beyond. Being a nurse has enriched and changed my life in so many ways. For that I am eternally grateful.

I still recall my first job. I felt like an impostor in my uniform.

I didn’t feel like a nurse because in my mind a nurse was someone who could start an IV blindfolded, resuscitate a patient while sleeping, and recognize all the signs and symptoms of septic shock at the drop of a hat.

Little did I know that there is no perfect nurse. There are nurses who are born skilled, those who are walking encyclopedias, and those who have the kindest hearts.

Combine all this and it’s almost like catching a glimpse of big foot, the tooth fairy, or even a leprechaun. With this in mind, the following are just a few recommendations for new nurses in the NICU…

Find your mentor
A mentor is a nurse that takes you under their wing and guides you. It may not be the mentor you were assigned to on your new unit, but you will find him/her. It often happens naturally. You find that nurse that loves to teach and your personalities just click. They are part teacher, part life coach, part parent or sibling, and eventually friend. They are the nurses you aspire to be. I have a trail of them across the globe.

Lori and her mentor Mary

Lori and her mentor Mary

You will be tested
The doctors will test you, the nurses will test you, the respiratory therapists will test you, and the parents will test you. It’s ok. It is normal. You have to prove that you have some clue, which you do! Trust me, you do! And with that, always trust your instincts.

Take care of yourself on your days off
Use your days off to enjoy your life outside of work. You work in intensive care. You need to find some outlet that has nothing to do with your job. Meet up with your friends, get a massage, run if you run, yoga if you yoga.

Handle with care
Our tiny patients are so delicate. No matter how stressed or rushed you are, handle them gently. Handle the parents gently. They are in shock and grieving. They need you.

Wash Your Hands
Hand washing still is the single most important thing you can do for your patients. Patients are still contracting and succumbing to hospital-acquired infections even in our most technologically advanced units. Our tiny patients have little to no immune defense.

Don’t Forget
When new nurses come through the door after you’ve worked a year or two, remember that you were there not long ago. Welcome them, mentor them, don’t talk about them when they leave the room. Be the positive example in your unit.

Welcome to the nursing profession! Best wishes on this exciting journey!

img006Lori is a NICU Staff Nurse  at Sahlgrenska University Hospital in Gothenburg, Sweden. After becoming a nurse, Lori traveled across the country to work a three-month travel contract in San Francisco, California.  Nearly five years later her journey continued to Gothenburg, Sweden, where she now lives and works.