Care of mothers with babies in intensive care
I work at a facility with a level IV neonatal intensive care unit (NICU) and it's my estimate that roughly (this is purely a guess) one-third of the mothers in my care have delivered babies that are in the NICU for whatever reason. Some of their physical assessment may be different (not by much) but the emotional aspect of their care is far different, and the range of emotions is about a wide a spectrum as can be.
Some women who deliver at my hospital have been there for days, weeks, or months already as antepartum patients and they are cognizant of the fact that their baby will be in NICU for at least some time. Others come to the hospital in preterm labor that cannot be stopped, and so they deliver a preterm baby that goes to NICU. Still others come in at term and deliver a baby that they expect to be healthy and stable and, for whatever reason, is not.
I think the foremost part of caring for these women is, well, caring. These are mothers of sick babies. They are worried about their babies. They may still be in shock that they delivered early, or they may be in shock that the robust eight-pounder that they thought was fine is not. It's not uncommon for it to take a while for the totality of the situation to 'sink in.' I've had moms that I've admitted that were all smiles and 'I feel great' come back in tears after their first visit to the NICU seeing their baby in the isolette with tubes and wires. They start to realize the gravity of what has just happened. The best I can do at that moment is offer a hug and/or a listening ear.
Some of these moms feel guilty - they feel that something they did contributed to their baby's NICU stay. And sometimes there is a connection, such as drug abuse or smoking, things that we know have a connection to preterm birth, low birth weight, and/or congenital anomalies. With these mothers, I try to build a rapport above anything else. Once that's there, it becomes easier to say, "You know what? Your smoking may very well have contributed to your baby weighing three pounds. That's not a judgement of you, just a statement of fact. Now that he's born, what he needs is your care and love and support."
More often than not, however, there is nothing that could have prevented their baby going NICU, and it's important for parents to hear that. Often they need to hear it multiple times from multiple sources.
It's important to make sure these moms have a picture of their baby if it's at all possible. It serves as a physical reminder that they are mothers. It also serves to help milk production if they have a picture to look at while pumping.
I try to schedule my care and assessments around their NICU visits, with the understanding that they do not have to ask my permission to go visit. At the start of my shift, I introduce myself and ask if now is a good time to
check them out. Once the initial assessment is done, I let them know if they have any meds (most common are Motrin or Colace) due my shift. I tell them I have no problem holding them til they come back, or if they want to come back to the unit to take their meds, that's cool too.
I do encourage moms to rest some. Having a baby in NICU is stressful and requires Mom to be at the top of her game, so to speak. Even if it's just for a couple hours, I encourage these moms to sleep. If they want me to wake them so they can pump, I'm happy to. If they want me to call NICU and let them know Mom wants to sleep and to feed baby formula should he need to eat, I do that too. I try to walk a fine line between encouraging breastfeeding/pumping (especially for a baby in NICU) and being overbearing.
There are a ton of questions to be answered, and I do my best to answer them, or direct them to a person who can. They may want a chaplain to visit, so I can arrange for that if need be. Or I let them know it's cool if their own clergy want to come. I make sure they have the NICU's number (that is actually encouraged by NICU) so they can call and ask questions if they are physically unable to visit baby. A few times I have gone to NICU myself and seen a baby for a mom that was too sick to go (at her request), so I could describe him and answer questions.
It can be hard emotionally as a nurse to care for a mom of a sick baby. But it's also important for me to remember that no matter how hard a time I am having, I am not the one whose baby is sick enough to need a NICU. I try to keep in mind that old adage as well that people don't care how much you know until they know how much you care. I find it doubly important for mothers (and families, by extension) in this situation.
I'm interested in hearing how others care for these moms, what issues you face, and how your hospital is set up to deal with issues they may face.
About Elvish, BSN, RN
Elvish has 'a few' year(s) of experience and specializes in 'Community, OB, Nursery'. From '221B'; 37 Years Old; Joined Nov '06; Posts: 20,517; Likes: 22,960.Jan 13, '09 by LoveTheNICUAs an NICU nurse, I just wanted to leave a quick note to say THANKS for the little extras you do to support these mothers! They most certainly need caring and supportive nurses throughout their postpartum experience. I know that your units are often crazily busy, so your dedication to assisting these mothers is wonderful. It also makes the NICU RN's job easier, as the mothers are receiving consistent answers to their questions, etc from both NICU and PP staff.
I have been noticing an alarming trend in my hospital of c-section mothers being cared for on the general post-surgical floor if their infant is in the NICU and postpartum is crowded, under the pretense that these nurses can care for what they are regarding as a post-abdominal surgery patient. However, when is the last time a med-surg nurse helped a mother learn to express breastmilk? Assessed a fundus? Provided emotional support regarding the prognosis of a critical infant? While I am not in any way implying that a med-surg nurse is incapable of performing these functions, they are just not generally considered part of a med-surg job description, and you can bet that these RNs have not been provided education on working with this population.
I will never forget the sight of a fresh postop C/S mom, less than 8 hours out, painfully walking to the NICU with two tiny drops of breastmilk in a bottle for her 24 weeker. After managing to pump with no instructions whatsoever, she has asked her nurse for a wheelchair ride, or simply if the nurse could walk around the corner to the NICU to deliver the milk to her baby, but had been told that the nurse was (rightfully!) too busy with her 8 med-surg patients to perform those "nonessential" functions. Knowing the importance of getting colostrum to her child right away, the mother repeated her requests over several hours before giving up and WALKING to bring it to us. This was a critical moment for me, and since that time, I always give the phone number of my workstation to every mother being cared for on the surgical floor, with specific instructions to call me directly if they need a ride to the NICU or assistance in any way. I am not faulting the surgical nurses, because Lord knows I could never do their job, but that day broke my heart.Jan 13, '09 by Elvish, BSN, RNI for one am glad that we have never had to house c/s patients anywhere but our floor....because the scenario you describe is indeed heartbreaking.
And, thank YOU for giving new moms your phone number in case they need help. That is a wonderful idea and can only make things easier for everybody. Thanks for your insight.Jan 19, '09 by memlz233I loved your story elvish. and, lovethenicu, that is extremely heartbreaking. I cannot imagine being a new mother with a preterm baby and being put on the back burner by these med/surg nurses. I know they probably did the best they could, but that's sad.Jan 22, '09 by ambrabergerI'm a NICU nurse and I appreciate hearing your take on caring emotionally for the moms of the babies. It's so important too. Thank you.Jan 22, '09 by sharpeimom, MSN GuideThank you all who work in NICU and give such wonderful, personalized and loving care. I am the only surviving triplet. I had two brothers who did not survive despite the fact that one weighed 5 pounds and the other 4.5 pounds while I weighed 3 pounds 2 ounces. After slightly more than 2 days of labor, a CS was finally preformed and we all had to be resuscitated and, from the bit of information my parents were finally given, neither boy could breathe on his own and without consulting either of my parents, they weren't resuscitated again (which I find way beyond appalling.) I wish so very much that some of you special people could have cared for my mom (and dad) postpartum. The OB forbid my dad's asking any questions and when my mom tried to get some answers, she was simply told, "Concentrate only on your little girl for as long as you have her." I obviously don't know the medical details of what my brothers might have faced, but my mom should have been treated more humanely. To end on a lighter note, one of my grandfather's friends saw me in my incubator and remarked to my grandfather, "Poor Charlie hardly got his seed back!"
sharpeimomJan 22, '09 by nicurn5As an NICU nurse, I have to agree that caring for these mothers takes a special brand of caring. I help to care for these moms after they have been discharged from our facility. They usually don't need any physical care but the emotional care is very challenging. It can be heartbreaking when you have to help a mom say good-by to their longed-for little one. Even a minor set back can be very upsetting to a mom when their child has made progress and must now take a step backwards. My unit is open 24 hours a day to accomodate the parents schedule. And by letting them know that we can answer their questions any time they have them, we encourage moms to call us even in the middle of the night when they are awake and attached to that "&*%$#* milker" (a somewhat direct quote!). Parents are not considered visitors to our unit; they are almost expected to be there at any time. We provide a couch for sitting on (and it converts to a single bed); they will nap when their baby naps. One of the hardest times is when a parent has "NICU psychosis" ( nurse's diagnosis) and in order for us to care for the mom, we have to encourage her to leave even for a hour to just get a break from all the stress she is feeling. We can work for days re-assuring her that she can leave to go eat dinner with her husband. When we are sucessful, we always hear from the mom as soon as she returns "how she needed that break." It can be one of the hardest parts of caring for the moms but it helps her in so many ways.Jan 30, '09 by midnitelpnI want to send a HUGE HUG to all NICU nurses! I had twins at 27 wks, one a gainer & grower & on w/nec w/ 7mos of complications & surgeries. she would take one step forward & 3 steps back the whole 7mos! i became a nurse because of these nurses! they took such good care of my kids, and even better care of me!!! i cant begin to go into all of the emotional support, educational support, patient advocacy, the list goes on and on!!! if it were not for the nurses in the NICU, i dare say i could have survived emotionally, quite possibly physically, if had'nt been for them! God bless your healing hands & hearts!May 8, '11 by SJerseygrleAs the mom of three NICU babies, I want to say thanks - the nurse who took care of me after my second son was born was the reason I chucked my succesful career and went to school to become a nurse. She sat with me (it felt like all night), and held my hand, listened to me worry about my son and even called the other hospital (he had to be life-flighted to a specialty hopsital) to see how my son was doing. I thought at the time "if I could do this for someone else it would make my life worthwhile."
In stark contrast to the daytime nurse who I called to ask her to give me the phone because I had finally got settled and couldn't reach it who told me "Don't worry, Im sure he's fine." She wouldnt hand me the phone either. Next bp: 205/100 - wonder why!
You sound like you are doing a great job - hopefully one day I'll be doing the same great job and can learn the ropes from someone like you.May 19, '11 by kmarcus5I am a student and my goal is to one day work in a NICU, and your post was very good. I like how you make time and provide special care for the mothers.May 20, '11 by jandra19I am not a nure or nursing student but with these post it just makes me feel like I would love working on the NICU. It can be a hartbreaker but it would make me feel very happy to do the most I can.May 20, '11 by sharpeimom, MSN Guidesince i posted on this thread in 2009, i have been able to learn a little more from a nurse who was in the or. the babies were conjoined, and only one baby had a working fully formed heart. i don't know how they were able to say what their weights were individually. estimates?
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