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.
sharpeimom
2,452 Posts
since 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?