Navigating the NICU: A Nurse's Guide for Parents

What is the NICU, and what can parents expect when their baby needs specialized care? In this episode, we sit down with a NICU nurse to discuss the NICU environment, common challenges families may face, and the medical equipment and care teams parents are likely to encounter. We also share practical ways parents can support their baby, participate in care, and navigate the NICU journey with greater confidence.

Blog post: https://www.functionalfourthtrimester.com/blog 

Transcript

SPEAKER_01 0:04

Welcome to Functional Fourth Trimester, a podcast created to support new parents as they return to daily life after having a baby.

SPEAKER_00 0:12

Each episode will talk through common postpartum challenges, share practical education and strategies, and hear from real parents and healthcare professionals along the way.

SPEAKER_01 0:22

Whether you're listening during a feeding, a walk, or a quiet moment, this space is for you. I'm Lauren.

SPEAKER_00 0:28

And I'm Melissa, and we're excited to jump right into today's topic.

SPEAKER_01 0:39

Walking into the NICU can feel overwhelming. Machines, monitors, and so many unknowns. In this episode, we are going to be talking with the NICU nurse about what a typical stay looks like, what you might see and hear, and how you can stay connected to your baby in the middle of it all. If you are in the midst of a NICU journey or you're preparing for the possibility, this conversation is here to help you feel more encouraged, informed, and supported. I'm pleased to introduce our guest today, Landry, who also happens to be my lovely older sister. Landry has worked for the past six years as a NICU nurse and has worked at two different level four NICUs. Welcome, Landry. Thanks for joining us. Hi, thank you for having me. So we can just start off with talking about for parents who might be walking into the NICU for like the very first time, what does a typical day kind of look like from your perspective as a nurse?

SPEAKER_02 1:35

Yeah, so most babies in the NICU we keep on a pretty regular schedule, both for the baby's benefit and for the nursing staff, since we're taking care of multiple patients. So it's nice for parents because they know when to expect to be able to help change a diaper, help, you know, take a temperature. So typically babies are fed every three hours in the NICU, sometimes every four hours, depending on their plan of care or their age. So every three or four hours, the nurse will probably come in, unwrap the baby, take a temperature, change a diaper, feed the baby, do an assessment. That's a good chance for parents to hold. Um, because we like to keep the babies resting unless we're messing with them, anyways. As a Nicky parent, I always try to emphasize to them to ask when are my baby's care times? When are my baby's touch times? Those are kind of what they're called, care times or touch times. That way you can be present every time the baby is, you know, awake and unwrapped.

SPEAKER_01 2:39

Nice. I feel like that would be helpful to have particular times and routines so that parents can like know and expect when they need to be present or when, like, if they are wanting to be present for those things, that they can be there. Um, I'm curious too. I also know you've done night shifts as well. So I'm curious, like, in your experience, like, do parents often get to stay there? Do they not stay there? Like, it what kind of involvement have you seen on the night shift side of things?

SPEAKER_02 3:05

Both of the NICUs I have worked in, the opportunity to sleep at the bedside is not available in the structure of the unit. There's just not enough space. So the unit I currently work in, they have a system called sleep rooms where you can sign up and it's kind of a first come, first serve. Also, who lives the furthest away and who has the sickest babies system. So they can sign up for sleep rooms that are on the same floor as the Nikki, they're just down the hall. So that way they can sleep and they can a lot of parents will come in for the care times. Um, a lot will just sleep all night and try to get some rest, but also be able have the opportunity to be close to their baby. I think the sleep rooms are especially useful when the babies are critical enough that we would need the parents to be there quickly if we if something were to go wrong. But sleeping at the bedside typically is not an option in neonatal ICUs. I know on more pediatric floors they're built that way, but in NICUs it's not typically.

SPEAKER_01 4:09

Yeah, that makes sense. But a cool concept to have a sleep room. I bet I can see how that would be. I could see how that would be nice for parents who do have those really critical babies and like want to be able to be there in you know a few seconds.

SPEAKER_02 4:22

Yeah. And being in such a big NICU, a lot of babies come from really far away to get specialized care. So the parents don't have a lot of other options.

SPEAKER_00 4:31

That's what I was gonna say. Having that option for people who can't just go home and come back and be able to have those care times is really great.

SPEAKER_02 4:40

Yeah. Another great option that most big hospitals have close by is the Ronald McDonald House, which is a nonprofit that um works with families that have children or family members in the hospital. So they parents can apply and stay there free of charge for, you know, a certain amount of time while their baby's in the hospital, and it's a couple miles at most from most major hospitals.

SPEAKER_01 5:04

Nice. Yeah, those are awesome. Um awesome. So I'm curious, you know, parents I feel like might often, when they're in the NICU, be super overwhelmed and confused by like all the equipment there. Like there's monitors, there's wires, there are alarms. Sometimes I'm not sure, like at your hospital, sometimes you have multiple babies all in the same like area. So you're hearing other kids' things. So I would love if we can kind of explain like what are some typical sounds that they might be hearing or equipment they might be seeing.

SPEAKER_02 5:33

Yeah. So every baby is a little bit different because every baby requires different levels of care. We have a lot of machines. What I like to do with parents, especially the first couple times they're visiting their baby, is I stand there with the parents and I go head to toe on the baby. Like, this is everything that's attached to the baby. This is everything that it's connected to. And then I go up to the monitor and I'm like, this is what this blue number means. This is what this green number means. This is what this yellow number means. And the caveat I always give parents, especially when the baby is brand new, that also means that the parents are tired. The mom has probably just given birth. So there's a lot going on. And so the caveat I always give is I'm gonna do this right now. And if you need me to do it again in 10 minutes, I will. Or tomorrow or the next day, because it's a lot. No, I always say no baby should have to go to the hospital. So there's no reason anybody should be able to absorb that information on the first try. Most of the time, I end up explaining all the different things to parents multiple different times in multiple different ways. And it's really important that if you are a Nikki parent and you don't understand something, ask your nurse. They'll tell you a million times. We don't mind at all.

SPEAKER_01 6:49

Yeah, I think that's awesome to make sure that parents know that they can ask those questions and that they don't have to just like wonder and be confused, but that they can ask, hey, what is what is this again? And I love that you're like, Yeah, we'll tell you, you know, a million times over and over again. And I'm curious to, I don't know, I don't think we touched on this in the first question, but I'm curious like, how often are like other professionals other than nursing coming in? Like, is I know nursing is the consistent thing that parents and baby are seeing. Um, doctors pop in, will other health professionals pop in?

SPEAKER_02 7:26

Yeah, so typically on my unit that I work on right now, on day shift, the teams of doctors round anywhere from like nine to noon. So these little clumps of doctors will move room to room, going over each patient, the plan for the day. It's great when parents can be at the bedside for rounds because they can hear the doctor's plans, they can ask questions in real time, and they can share any concerns they have with the doctors. So, a lot of doctors. Um, we have occupational therapy, we have physical therapy, we have speech therapy. All babies get an occupational therapy and physical therapy referral. All of them will see one or both while they're in the NICU at some point. A lot of the times, if a baby just needs to be in the NICU for a little bit, they only see those specialties once or twice. But our ex-premies need a lot of developmental care. So our therapy specialists work with them pretty intensely. We also have surgeons that will come by and round if a baby has had surgery, if a baby might need surgery. We have cardiology, we have brain doctors, um, endocrine doctors, gastric doctors, a lot of lot of people. I always tell parents, especially on Mondays and Tuesdays, it's kind of like a revolving door, especially on the more complex babies. It's just one person after the other. So it's a lot of people. And it's really important too for the parents to be like, who are you? And that's an okay question to ask because there's so many people, and sometimes they have a lot of babies to see, so they kind of forget to, you know, stop and introduce themselves.

SPEAKER_01 9:07

Yeah. Yeah, that was something I noticed even in like my adult inpatient rehab fieldwork rotation, is like sometimes I'd be working with a patient, a doctor would come in briefly and then leave, and the patient would be like, Wait, who was that again? Like, I don't know which doctor that was. So I think it's so important for parents to know that that's something they can ask, especially that it's also okay to stop the professional and be like, Can you introduce yourself and remind me who you are? Even if you literally met them the day before, you know, like it's it's okay to get to get that clarification so you know what they're there and what they're doing.

SPEAKER_00 9:43

Yep. So I get curious because obviously I've never been an IQ mom, but I can imagine, you know, the anxiety that would come with that situation, the stress, uh, a lot of the unknowns and not knowing, like you're talking about right now, not knowing who's doing what and why. Um so are there ways that in like the hospitals you've been in that you support outside of, you know, informing them this is what's happening, this is what we're doing. Ask the questions. Are there things that are in place to kind of help support the families with that stress that they're feeling or that anxiety to kind of manage that piece of what's happening?

SPEAKER_02 10:23

So I think that's an opportunity for growth in both the NICUs I've worked in. And I could pretty confidently say a lot of NICUs probably are the same way. Just because I think myself as a nurse, especially when I was newer and a lot of the providers as well, I think we get so focused on taking care of sick babies. Oftentimes we forget. In my mind now, the parents are my patient as well. And I try to keep that mindset and I tell all of the new nurses I trained to do the same thing. But I do think that's a bit of an opportunity for growth in many NICUs. The previous NICU I worked in, I know some of the parents themselves formed like a Facebook group that was kind of like a support group. And then we had a Facebook group for like all our NICU grads where they could share like, you know, questions and going home pictures and you know, nice stuff like that. But I do think there's a lot of um gaps in the healthcare system when it comes to supporting parents of children and babies that are in the hospital for extended periods of time. Makes sense.

SPEAKER_01 11:29

Definitely. Yeah, I can see how that would be a thing. So hopefully the we could just keep developing more resources and services to be able to support. Because I think too, it's like I feel like that is a population that sometimes gets overlooked a little bit. Um, you know, like when you think about a lot of the typical postpartum resources that are targeted as like if you're home with baby versus okay, but what if your baby's not home yet? Yeah. Yeah. Um and I think something I've like heard from you know NICU parents when I talk in the past um is that like they can feel scared to really interact with their baby and like get involved with their baby at all and kind of especially if they're brand new, you know, have that bonding and get to know them. So, what are some like meaningful ways that parents can be involved in their baby's care even while they're in the NICU?

unknown 12:19

Yeah.

SPEAKER_02 12:20

So for a lot of moms, I know pumping is really important to them. A lot of the times, NICU babies are not able to breastfeed right away or even bottle feed right away. So a lot of moms feel very strongly that pumping is something they can do if that's right for you. Um I really like to involve parents in the care times, the every three hours. So I always offer to help them change the diaper, help them take the temperature. And if the if they're either too nervous to do that or if the baby maybe has a little bit too much going on, where I would prefer to do it. Um, there's something we do in the NICU called a hand hug. So I'll teach the parents you put one hand on top of the baby's head, like gentle pressure, and then one hand on their arms, kind of like cross like this, because babies self-soothe like this, even NICU babies. Um, so I kind of teach them to do a little hand hug. That way, when I'm doing my part of the care time, which babies typically get a little annoyed about, the baby can stay a little bit more calm. And I think that's really meaningful for the parents to be like, I'm helping keep my baby calm because you are, because you are the main thing to help calm down your baby. Another thing I try to really do a lot is um skin-to-skin kangaroo care, if the baby is stable enough for it. Kangaroo care is has so many health benefits for moms and for babies. So as a Nikki nurse, I want my babies to do that because I know they're gonna do better afterwards too. We also have if a baby is too unstable or attached to too many machines for um kangaroo care, then we have these little scent cloths. So they're like little pieces of fabric just this big, and the moms will wear them and the dads can wear them too inside their shirts, and then um they'll take them out after a few hours, and we'll just put them right next to the baby so that the baby has um the parents smell next to them.

SPEAKER_01 14:15

Oh, that's sweet. I haven't heard of the little scent things. That's cool. Yeah, and I think it's I think a lot of parents don't know that like the skin to skin, the kangaroo care can be an option. I think a lot of times you see them hooked up to different things and they're like, well, I for sure can't touch them. Um so I think it's super important to make sure they're asking their their nurses, their doctors, like, is this, you know, is my baby stable enough? Is this something that I could do? And then they'll be shown and helped with it. So I think that's awesome.

SPEAKER_02 14:44

Yeah. And I run into a lot um parents being too nervous, even when I offer um for them to do skin to skin or other things. And I want to emphasize to parents that your NICU nurse is not going to offer you something that is dangerous to your baby. I always tell parents, I said, I would not be like offering this to you if I thought that something was gonna go wrong. So I think it's important to know that if your NICU nurse is saying, you know, do you want to do XYZ? Your NICU nurse is confident enough to help you with that that it will be okay, even with all the machines.

SPEAKER_00 15:18

I love that you say that because I could see how like they don't want to hurt their baby. There's a lot of wires and monitors, and so that case of anxiety. That is something you're like you said earlier, that you try to remember that the mom and dad, they're your patients as well. So that is something you're doing to be like, I I have you, I wouldn't put you in a position where you're gonna hurt your baby, like it's okay, let me support you. I love that because that would be a big fear, I think. They don't want to cause any extra issues, but yeah, that's awesome.

SPEAKER_01 15:52

From your experience as a nurse, what are some of like the most common struggles or worries that you feel like parents are sharing with you or that you're just observing during their NICU stay?

SPEAKER_02 16:04

I think for moms that are pumping specifically, which not every mom, that's not right for every mom, but for moms that are pumping specifically, a lot of them have trouble with their milk supply when they have a NICU baby because quite frankly, your baby's not supposed to be away from you at the very beginning. That's not natural. No baby should be sick and laying in a bed while you can't be there 24-7. It's it's it absolutely sucks. So a lot of moms have trouble with their milk supply, I think, just because of the anxiety, the lack of sleep, your baby not being physically close to you. So a lot of moms have shared that with me. And we have lactation consultants in the NICU that are NICU specialized, and they're absolutely fantastic. So they're really helpful resources with that. Um, a lot of parents, too. I think the most frustrating thing is when a baby gets really close to going home or like starts to get closer to going home, we cannot ever tell them we know when they're going home. Nikki babies are notoriously bossy and chaotic. And every time you think that they're about to go home, they'll throw some wrench in your plan. And I think that's really frustrating for parents because I have rarely seen a Nikki baby without at least one setback. And I think a lot of parents, you know, it should move in a linear fashion, like your baby's progress. But unfortunately, Nikki babies don't do that. So, and I think nobody really thinks about that until they have a Nikki baby and they experience it. So that's really frustrating for a lot of parents.

SPEAKER_01 17:40

Yeah, I can see how that would be because they're like starting to be like, oh, okay, they're a little bit better, like starting to kind of dream up what it's going to be like at home and think about that, and then to have to like have a setback and kind of have to alter their thoughts about like, oh wait, maybe we don't get to do that right now. Um, I think the mental load of that would be would be really hard. Okay, my last question I have is, and like we've talked a little bit about this, I know, but like, is there any other kind of advice or reassurance that you find yourselves giving parents a lot that you kind of wish that maybe if somebody's listening to this and they're in the NICU and like super stressed, super confused, and like what's some advice you feel like you keep you get you give parents often?

SPEAKER_02 18:22

Yeah, I think my main one is I will tell parents in the first few days, keep either a note in your phone or if you have a physical notepad, that's great. Any question you think of, it doesn't matter how stupid or little it is, it's not, write it down because when someone walks into your baby's room and says, What questions do you have? There will be nothing in your head. And I have seen it time and again. They're like, I have no idea because you're overwhelmed and your brain isn't is it's on survival mode. So I always tell them, write down every single question you have if you think of it at two in the morning when you're pumping, if you think of it when you're in the shower, anything. Write it down that way. You have those questions when the doctor comes in and asks what questions you have, because make you babies are very confusing. So a lot of parents have a lot of questions, and if they then think of it later and they ask me a question that maybe only the doctor knows, sometimes I can't get a hold of them for a little bit, you know. So having that written down is kind of the main advice I give parents because I think it gives them a sense of like calm and control over, like, okay, I'm gonna get all my questions answered today.

SPEAKER_01 19:36

Yeah, absolutely. And I think it's it's so important to highlight, especially like, you know, most of these parents have just gone through having a baby and like they're having their own like hormonal shifts and recovery and like physical recovery. And so, on top of all that, having to like keep a list of mental questions in your head to remember is just near impossible. It's too much. So I think it's awesome, an awesome recommendation to just like jot things down and to know that like you can ask literally whatever question you want, like if even if you feel like, oh, this is a dumb question, like it's still okay to ask. And yeah, you know, your nurses and your doctors want you to ask your questions.

SPEAKER_02 20:16

I always tell them, ask me any question you want, there's no stupid questions, and ask me the same question a million times if you need to. If I didn't explain it the right way the first time, tell me that you don't understand what I'm talking about. I will think of something else. I will figure out a different way to explain it.

SPEAKER_00 20:33

I think this is so important because I I don't know that there would be any families that would say, let's have a baby and we're gonna be in the NICU when we have the baby. Like people don't envision that when they decide to have a baby. So that this the NICU journey is something that people aren't imagining when they have the baby. It's not something they're really preparing for most of the time. People aren't really preparing for it at all. So being there to support them and say, like, ask the questions, we'll answer them because they probably aren't researching to better understand what that journey is gonna look like. Um, and then being able, you know, parents being a like understanding that it's okay that they're they're dealing with the stress of this whole hospital NICU situation and also the loss of what they had imagined. Because earlier you were talking about how you can't really tell them when their baby's gonna go home because there many times is a setback, and so um, they keep imagining and waiting for that moment that they were envisioning from the beginning when they had their baby, bringing it home from the hospital. So all those emotions and things that they have to deal with are so huge. And though you said that there's room for growth and support for families, I feel like you guys, like at least in the space that you're in and what you're doing, you're doing the best that you can while still managing everything that you have to manage for the infant's care because it's not just that one baby. You have multiple babies that you're taking care of and multiple families that you're trying to manage. So the goal is continued growth for care within all of the postpartum space in the hospital, outside the hospital when they get home. But always knowing what it looks like moving forward for growth, I think is important.

SPEAKER_01 22:20

Yeah, absolutely. I would love to thank our guest speaker, Landry, for joining us today and sharing about her experience as a NICU nurse. I hope if you're listening today and you're in the midst of a NICU journey, you feel like you have just a little bit more encouragement and support on how to navigate that experience. I think the biggest takeaway from what I was talking about was to not be afraid to ask questions and to ask how people be involved in your baby's care and to really get some of that bonding kind of stuff. In the description to this episode, I will add a link to our blog post, which will have more information and education about this topic. Thank you all so much for joining us today, and we can't wait to talk with you next time.

SPEAKER_00 23:14

I hope today's conversation gave you something practical to take into your day or simply remind you that what you're experiencing is normal. Returning to daily life after birth is a process and support matters.

SPEAKER_01 23:26

However, your day continues from here, be gentle with yourself. You're doing important work. Thanks for listening. We'll meet you back here next time.