An estimated 10 to 15 percent of births result in NICU time, with the majority of those being babies who are born premature and who simply need to be placed in incubators while their bodies develop their ability to maintain a healthy temperature. However, full-term and preterm babies may also spend time in the NICU for any number of medical complications, commonly including trouble breathing, cardiac distress, and sepsis, says neonatal nurse practitioner Rachael Zastrow, NNP-BC, president of the National Association of Neonatal Nurses.
In some cases, the pregnancy complication that sends a baby to the NICU is directly tied to a health condition in the birthing parent, like preeclampsia, “so you’re trying to cope with what’s physically going on with you, while processing the fact that your baby is also sick in another room,” says lactation consultant and nurse Deepa Cruz, RN. The above scenario, in particular, may isolate a birthing parent from their newborn in a profound way. “A mom in this situation once described how it felt to me by saying, ‘I don’t feel like I know how to be a mom because I don’t even feel like I had a baby,’” says Cruz, who is also an advocate for Poppy Seed Health, a telehealth platform that provides support for pregnancy, pregnancy loss, and postpartum health, including care advice for NICU parents and their loved ones.
“The baby could be very sick and have a breathing tube, or they could just need oxygen, but for the parents, their perception is that their baby is not normal.” —Rachael Zastrow, NNP-BC, neonatal nurse practitioner
Regardless of why a baby is in the NICU, the situation can be a particularly unsettling event for the parents. “The baby could be very sick and have a breathing tube and an IV, or they could just need oxygen," says Zastrow. "But for the parents, their perception is that their baby is not normal.” And loved ones of NICU parents should be cognizant of the fact that they may be experiencing these scary, disheartening feelings from the get-go.
Below, Zastrow and Cruz share advice for how to best support NICU parents during this high-stress period.
The 5 most helpful things you can do to support NICU parents
1. Listen, listen, listen
Just as you might support someone going through any kind of trauma by listening as they speak, simply lending an open, non-judgmental ear can be of huge help to NICU parents. Focusing on listening ensures that you honor the experience they’re having, instead of clouding it with your insights, birth story, or advice. “Unless you’ve been a NICU parent yourself, you won’t have any idea of what they’re going through,” says Zastrow. (And even if you were a NICU parent, chances are, your journey didn’t take exactly the same path as theirs currently is; while you can share your experience if you’re asked, it’s still a good idea not to offer advice, given the fact that every child and parent’s NICU experience is unique.)
It’s also smart to ask, “Do you feel like talking?” before asking any questions about their status or that of the baby, says Cruz: “They may really want to share with you how much weight the baby gained that day or how they’re doing on certain good days, or they may really want to vent on some terrible days. But they also may not want to talk.” Asking if they’re open to talking before diving into a conversation is a way to respect their boundaries.
2. Offer to help with everyday life tasks
Managing the regular demands of life is often the last thing on a NICU parent’s mind while their newborn needs medical care and treatment. But, of course, those other responsibilities don’t simply disappear—which is where loved ones can play a critical role, says Cruz. “You might ask if you can help walk their dog or get them groceries or even come do laundry for them,” she says. “It’s about trying to restore balance when there’s imbalance going on.”
“You might ask if you can help walk their dog or get them groceries or even come do laundry for them. It’s about trying to restore balance when there’s imbalance going on.” —Deepa Cruz, RN, neonatal nurse
You can also offer to help take care of other kids that these parents may have at home, says Zastrow. “Often, NICU parents are torn between wanting to be at the hospital with their baby who was just born and wanting to be at home for their other kids,” she says. Having a trusted relative or close friend at home can give them much-needed peace of mind while they can’t be in two important places at once.
Because time is of the essence for NICU parents, even making food for meals can feel like an undue burden—which is why both Cruz and Zastrow also suggest offering to cook dinner and deliver it to their home ahead of their return each night. “I can tell you that moms and dads in this situation don’t eat,” says Zastrow. “And particularly for mom, if she’s breastfeeding, eating is extremely important.” While you can certainly ask what the parents would like for dinner, if you don’t have much access to communicate with them, focus on high-protein meals, as protein is essential for healthy breast milk, Zastrow adds.
3. Gift thoughtfully for baby and parents
Focus your gift-giving efforts on useful things, says Zastrow, like a big blanket or calming tea or snacks for the parents. (And save baby gifts for when they’re hopefully discharged.) It's also important to note that things like balloons, flowers, and champagne won't be allowed in the NICU, so avoid sending those items to the hospital.
Another gift option for either parent? Big, inexpensive button-down T-shirts. Often there comes a time in the NICU when a parent may be able to pick up their child and hold them skin-to-skin in an embrace called “kangaroo care,” which has been found to be both emotionally and medically beneficial. But breastfeeding shirts don’t typically leave space for the tubing or other apparatuses that may be connected to a NICU baby, which is where oversized button-down shirts come into play, says Cruz: “These shirts ensure that they can create enough of an opening to hold their baby directly on their chest, which is something that both mom and dad can do.”
4. Be a communication liaison for other friends and family members
Keeping family and friends updated on the status of their baby can become a difficult task for NICU parents, in and of itself. Particularly when the news they have to share is not good news, it can also be psychologically distressing to have to repeat it five different times to five different people, says Zastrow. To help your loved ones avoid that scenario, you can offer to be the point of contact for everyone else; this way, they can share what’s going on with you, and you can disseminate it to people whom the parents would like to stay informed.
Zastrow also suggests offering to set up the parents on CaringBridge, a website that allows parents to journal the NICU experience and then give family members a login to their page, so they can all be notified whenever a new update is added. Alternatively, you can offer to do the writing for them, if they’d just prefer to tell you what’s happening rather than write it down themselves. “This is a great tool for parents of babies who are very sick and have an extended stay in the NICU because they often just don’t want to take another call or tell another person that their baby isn’t doing well,” says Zastrow. A CaringBridge account also creates a digital log of the NICU journey that parents can look back on and use to reflect on how far their baby has come, once they're hopefully discharged, adds Zastrow.
5. Be supportive of breast-pumping efforts
Whether a new parent decides to breastfeed or chestfeed is entirely up to them. But no matter what they choose, managing breast milk supply when a child is in the NICU is a particular challenge.
“During those first couple days postpartum is when the mother produces colostrum,” says Cruz, referring to the protein-, vitamin-, and mineral-rich liquid that is designed to support a newborn’s immune system. In fact, it’s so nutrient-dense, it’s often called liquid gold, says Zastrow, “but pumping it can be difficult in the hours and days after birth when you’re not able to put your baby to breast,” she says. In turn, it’s especially important for anyone in a NICU parent’s sphere to be supportive of any efforts they're making in this direction, says Zastrow.
In situations where a NICU mom is pumping breast milk, but they still can’t access or feed their baby, that milk also needs to be stored in a freezer, says Cruz, “and if they’re pumping six to eight times a day, even the freezer bags are going to quickly fill that freezer.” A simple way to support these efforts is to open your freezer to them, she says. “Offering to store this key resource for a loved one’s baby will ensure they have it available whenever they can start feeding.”
3 things to avoid doing when your loved one has a baby in NICU
1. Do not ask them when their baby will leave the hospital
They don’t know the answer to this question any more than you do—and asking can generate more harm than good. “Every time someone on the outside asks a NICU parent when their baby is coming home, it only serves to heighten their anxiety and apply additional pressure,” says Zastrow. “I’m a neonatal nurse practitioner, so I’m a provider of care for these babies, and often, we won’t even know 24 hours beforehand that a baby is going to be ready to go home.”
2. Don’t only support the birthing parent
“A lot of time and attention is often directed toward the mom of the child because of things like breastfeeding or pumping, or things that only mom can do, but it’s important to remember that [a non-birthing parent] may be as much in crisis when their child is in the NICU,” says Zastrow. Be sure to ask all parents of a NICU child what support they may need and involve them in the support you’re offering.
That might look like asking a non-birthing parent what you can do around the house, how you can take care of other kids at home, or what they’d like for dinner, rather than just directing these questions at the birthing parent. “This can help a father feel involved and feel like they can help manage things outside the NICU during this tough time, as well,” says Zastrow.
3. Don’t stop offering love and support when the baby comes home
It can feel pressing to do something for a loved one immediately after their child is born and lands in the NICU—and that’s certainly a valid feeling—but it’s important to remember that “the moment when that baby comes home is as important a time as when they’re in the hospital,” says Zastrow.
Because NICU parents are stripped of many celebratory joys at birth, Cruz suggests commemorating the baby’s arrival at home by sending the balloons, flowers, and other goodies you might’ve initially wanted to send when they were born (but couldn’t due to NICU policy). “Treat the discharge like a delayed celebration of having a baby,” she says.
In the days that follow, the parents will be learning how to adjust their everyday life and fit within it a newborn who may still need additional care and attention—which is why Zastrow also suggests continuing to lend a hand, if you can. “This is often when the support peters off, but it’s also when the parents tend to need it more than ever,” she says. “During these days following their return home, a cooked meal every now and then or an offer of additional child- or pet-care can be so helpful, allowing the new parents some overdue time to bond with their baby in their space.”
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