The NICU Translated Podcast

Mary Farrelly (00:00)
If you've ever heard the term NICU doula and thought, wait, what is that? You're not alone. Even many birth and postpartum professionals have never heard of it. But if someone who spent years in the NICU as a nurse, a doula and an educator, I can tell you that NICU doulas are filling a huge gap in support for families. And today I'm going to tell you exactly what a NICU doula is, why families deserve one and how this role is transforming the NICU experience.

Hi everybody and welcome to this week's episode of the NICU Translated Podcast. This week I'm talking all about a role that is really the core foundation behind the work that I do in the NICU Translator, both One-on-One with Families and in the education and training that I do. And that is a NICU doula. And oftentimes when I start talking about the NICU doula work, oftentimes I'm like kind of met with these blank stares of like, what?

What is that? People are both confused but also very curious because I feel like instinctively it makes sense. We know what the NICU is and we know that families in the NICU and babies are going through an

incredibly challenging and transformational time. And then people are more and more familiar with the term doula. So let's start there. What is a doula? The definition of a doula is a little hazy, but in general,

It's somebody who is a non-medical professional that is trained and specializes in helping a person, a family, or a group through a transition or a transformation. So we know that doulas are incredibly powerful and active as birth doulas and helping families navigate pregnancy and their birth journey. As postpartum doulas, where we help families really integrate.

life at home with a newborn and supporting them with logistical, practical, emotional, and educational ⁓ guidance. And also there is a growing field of remit and death doula work, so helping people and families navigate the transition into end of life and what that looks like and feels like for those families. But before really the last couple years, the idea of adding

doula into the NICU space was

a little bit unheard of. ⁓ Not entirely, I did not invent the term NICU-Doula ⁓ But I feel like there was always or has been historically this idea that the NICU space is so medicalized and the babies and families are so vulnerable that we don't want to cause harm by letting other folks into this space that maybe don't have the knowledge, understanding and skill set to support.

the very unique needs of a NICU baby and their families. And as a NICU professional, as a NICU nurse, I understand that feeling. We are very protective of the NICU and there's a lot of reasons for that, right? Their babies are vulnerable to infection and exposure and families are vulnerable to people who maybe have well-meaning intentions, but again, don't have the words or the knowledge to support them and so sometimes can inadvertently cause.

unintentional harm. but that being said, NICU families are going through birth, postpartum, all sorts of incredibly intense transitions and deserve even more so to have this type of doula support. Doulas that are there to offer emotional support, practical support, logistical support, educational support to help fill the gaps in the work that the medical care team does. So,

Working at the bedside as a NICU nurse in the NICU setting, right now the idea and the tools and the concepts that a NICU doula can provide to a family is sometimes offered through different roles in the NICU. Oftentimes the NICU nurse is expected to be able to offer emotional support to families, help them with the feelings of lack of knowledge and understanding and helping them find their ability to advocate.

and understand their baby's care and understand the complexities of the NICU hierarchy and medical system and even beyond in the life after NICU journey as well. Sometimes this support might come from social workers, case management, child life. There's often different players, but having worked in healthcare for well over a decade, ⁓ I know it's kind of like that Instagram versus reality, right?

In theory, on a perfect shift as a NICU nurse, if I was incredibly well staffed, had all the resources that I had, had an appropriate level of acuity assignment, and there were no curveballs thrown at me throughout the day, as there often is as a healthcare provider, I probably did strive to show up as both a NICU nurse and a NICU doula for my families. Wear that hat of emotional support and advocacy and be able to really sit down and understand them and their own

story, their own physical needs, their own fears, their own unique story. But oftentimes the reality of being a healthcare provider really limits your ability to offer this type of care. As a nurse, I am trained to be able to support the medical needs of the baby. That is where the bulk of my education when I was onboarding new nurses as the nurse educator for my unit, the bulk of our training is the

pathophysiology, the understanding of the disease processes, the equipment, the physical hands-on care, really integrating into the medical team, but we get very little, if any, training on how to support the unique needs of the family because is, The NICU was very unique in that the baby is our patient, but the family is intertwined in a way, really unlike many other.

settings in healthcare. The family is always a part of the medical ⁓ sphere, even if you're working with adults, but especially in the NICU, ⁓ there's this unique dynamic. But there isn't often there are resources, education, tools, time even to really show up and support families in a way that is meaningful and enough.

Families oftentimes, I mean, the times I have a very specific memory working at the bedside and I had two patient assignment in the ICU setting, I had one baby that was having a acute medical crisis and my other patient, the family was having an acute emotional crisis. And I had in that moment to choose and rightfully so, the medical needs of that baby because that as a healthcare provider was always gonna be my priority. And at the time,

there was really no designated person that I could send to that had the time, training and resources to be able to support in the moment that emotional needs of that, of my other patient, other family. That was one of those formative moments when I was like, I could see the trauma happening for my other family. I could see it happening in front of my eyes and felt this sense of powerlessness and disappointment that I couldn't.

help them navigate it in the way that I knew they needed to. And really feeling very helpless with my lack of abilities to support. And that in healthcare can feel like moral distress, that feeling like you know the right thing to do, but you don't always have the ability to do it. So that memory really tied into my mission to bring

NICU Doula work to families in so many different capacities and we're going to talk about what that looks like. But really one of the incredible things about the role of a NICU Doula is the potential positive impact for so many people that are involved. So that family that was in crisis having a NICU Doula that is trained in the ability to have a trauma informed care conversation, understanding how to connect them with resources that are unique to that NICU.

really just showing up and being present and bearing witness, not obviously offering psychotherapy or other resources, just being that constant presence, that listening ear, ⁓ really could potentially change that family's long-term impact. We know that the mental health outcomes for NICU families are dismal. About 70 % or more of NICU families experience some form of a PMAD add or...

mental health issue after discharge and that can range from postpartum depression, postpartum anxiety, postpartum OCD, and about 40 % of NICU families have clinical PTSD or post-traumatic stress disorder after the NICU. And I think that

There's nothing that we can do to totally take away the hard of the NICU setting. Like the NICU is always going to be hard. It's an ICU. There's uncertainty, there's fear, there's overwhelm. But by not offering an outlet or a way to support families mentally, we're really setting families up for these high numbers. And I feel like they are too high. And it's part of my work and my mission to decrease those numbers and to see the impact of having a NICU Doula supporting people in this capacity. So we know that

NICU doulas are going to benefit the family with their unique skill set in postpartum care, in trauma-informed care, a unique understanding of evidence-based practices and bonding and support and what the NICU is like for families so that they are not just stepping into this blindly and again, knowing how to navigate the very unique landscape and language of the NICU setting.

We know that then in turn a supported family who feels cared for has their physical needs met, has their emotional needs met, will then be able to then show up for their baby in a way that they may not have been able to before. If you don't feel well, if

needs are not met, if you're hungry, if you are overwhelmed, if you're sleep deprived, you simply cannot be the advocate that maybe you want to be for your baby. You can't learn, you can't show up in the same way.

So then by having the families feel supported, then the babies will feel more supported and they will have better outcomes, more time bonding and connecting, more time having a parent be able to really understand and advocate for their unique needs, having a parent who's really awake and alert and ready to learn how to feed their baby and how to think about and plan and prepare for life after discharge.

So we know that potentially a NICU Doula by supporting the family, will then inadvertently be supporting the babies. A NICU Doula in the NICU setting especially is not going to be delivering hands-on care of the baby. The role of the NICU is to be able to empower and educate and support a family so that they feel like they can step into that parenting role with clear eyes and a whole heart and a full belly and be ready to step into their parenting journey because

It is unique and it's often very disrupted for families that go through the NICU as their early parenting experience, especially for first time parents. And we're going to talk about all of that in another additional episode. But another place that I firmly believe NICU doulas can truly help is decreasing burnout of healthcare providers. As I mentioned before, we, the concept of moral distress means that NICU providers often go into the NICU as a healthcare specialty because we have a

passion for serving and impacting NICU babies and their families. No one chooses NICU because they're like probably pretty easy or pays really well. I mean, that's not the motivation behind choosing NICU. Usually the people that are in the space that are my colleagues that I've worked alongside for decade plus are incredibly passionate, supportive, and just really special people that choose the NICU setting.

But there's a real compassion fatigue, a real burnout of having to show up with your whole self and your most powerful, supported, listening ear at the same time while you're trying to provide clinically excellent medical care for incredibly complicated and fragile babies. It's really hard. And so that can lead to a lot of compassion fatigue, which ultimately leads to burnout, which can lead to turnover, turnover being nurses and other healthcare professionals.

that leave the bedside or leave that specific NICU and go into different work. And we know especially post COVID that the turnover rate for nurses in general and in the NICU as well is really high. And that can impact medical outcomes for babies because turnover means that there's a lot of people at the bedside that are not as experienced or not as invested in that particular hospital system. The culture might be a little bit off. You just have this underlying feeling that everyone's

Really tired. So having a NICU Doula there to be able to take away the burden slightly, know, healthcare providers are still going to be able to show up for their families and offer that emotional support. But knowing that someone else is caring for their family in that unique way, you're going to have a much stronger ability to form a bond and a relationship with that family because they're going to be a better version of themselves. Everybody wins by having

a trained and invested NICU doula, being able to support families along the full trajectory of the NICU experience. So the interesting work as a NICU doula is that unlike a birth doula or a postpartum doula where there's a very finite kind of window of where they're showing up to support families, like a birth doula is there during pregnancy and birth, a postpartum doula shows up after the baby is born.

A NICU doula really can specialize and even follow a family along the entire continuity of a NICU experience. And the unique background and skills and passion of the NICU doula can really help align where they might find their purpose and their best work supporting NICU families. So the NICU starts.

Experience for many families starts well before the baby is even born. Sometimes, not often, but sometimes families do know prenatally that the NICU is going to be part of their experience. They may be able, because of that, have maybe a NICU tour, maybe a NICU consult where you talk to a NICU doctor for a period of time. But oftentimes those conversations are brief, right? Those maybe total two hours, if you're lucky. And they don't really talk about

the emotional and practical aspects of what a NICU experience might look like for their family and give a family the space and the time to really think about how they might want that experience to look like for their family and what that might look like in terms of rhythms and routines and practicing and setting up for pumping success in the NICU and what does this look like for supporting a sibling?

NICU doulas who are trained in prenatal support of NICU families are an incredibly essential piece of helping to build out these conversations and resources for families to help step into the NICU feeling way more prepared than 99 % of NICU families do. Most of the time when a family comes to me at the bedside, they look like a deer in headlights because no one has even mentioned the word NICU to them. Even if they were high risk, they maybe had very minimal conversations about the NICU. They might not have even known that they were truly high risk.

and what the statistical likelihood of them having a NICU experience was. And that being said, my firm passion, and we're gonna talk about this in a future episode, is that every single pregnant person should have at least a bare basics understanding of what the NICU is and how they might want those early days and really hours and days in the NICU to look like for their family and how they can feel the most supported.

for every single pregnant person because we know that for most people the NICU is unexpected and it can happen very quickly. So a lot of NICU doulas are potentially also trained birth doulas or they're integrating into childbirth education classes or they're working with maternal fetal medicine specialists and helping to have families feel more prepared so that the...

potential trauma of the NICU stay is maybe, again, we can't take that away. We can't take away the overwhelm. You can feel as prepared as possible in setting foot in the NICU for the first time and seeing your baby there is always going to feel really, really hard. But by having a piece of preparation, families can feel a little bit more empowered and a little bit more in control to the extent that we know that they have an understanding of how they want the experience to feel and an understanding of what that might look like.

so that then it doesn't feel immediately this sense of overwhelmed, chaos, powerlessness. So this also might look like antepartum rounding. One of the recent graduates of NICU Doula Academy is going around with antepartum team for mothers who and pregnant people who are on bed rest or admitted to the hospital for an extended period of time and having bedside NICU Doula conversations and helping them feel more prepared and supported even just through their antepartum stay and also...

preparing for the logistics of a NICU stay. Then we touched on a little bit during this episode about the during support. So what does that look like as a NICU doula? A lot of it is just unlimited potential for presence. A NICU nurse and a doctor and a respiratory therapist and a social worker.

We are running around like chicken with our head cut off 99 % of the day. There are so many to do, so many tasks, so much charting, so many people to see and not enough time in your shift to just sit and talk and listen. And a NICU doula in theory, that is their role. That is the time to sit and talk and listen. Help families process what they're going through. Maybe understand and say, hey, rounds are coming up. Do you wanna bounce off?

with me, like what questions you might have for the team. Can I help you prepare for that so that when rounding is happening, you can feel really like you're getting your questions answered and that you feel like your voice is being heard and that you understand the updates that are going through. We can help by offering practical resources that are unique to that NICU setting. Not every family knows what even options are available to them, whether it's a support group or having, you know,

Did you know that they do free lunch on Thursdays? Or here's a bottle of water. You look like you haven't drink anything today. Here's our thing of chapstick. Here's a book that you can read to your baby. Did you know that this is our NICU protocol or policy for how reading supports NICU impact? It's really helping families again, feel heard, seen and like a parent. And this might also look like offering some basic postpartum physical support and care, understanding

and helping families heal from their own birth experience and feel like, again, they don't just have to sit in a plastic chair and be like, there's no pads here, even to change my pad if I wanted to. I don't know where the bathroom is. I don't know how to stand up. It's really filling in those postpartum gaps because another thing we know is that NICU families are a much higher rate of readmission for themselves post-discharge after a NICU birth experience. And much of that comes from their own

physical neglect of their body because immediately once the NICU family sees their baby there they go to fight or flight and to how can I be here and show up for my baby and their own physical needs just go right to the bottom of the barrel and a NICU doula can help Bring those needs to the top and meet those needs too because it's not usually really complex things But it's often things again that NICU nurses and professionals are not either trained in I was I'm not a postpartum nurse. I have

postpartum doula training, but most of my colleagues do not. So we simply feel out of our depth and out of our skillset when someone asks a question or asks even for a pad to change after postpartum. And we know that that's something that families really need. So even just having the basics available and having those conversations and giving families permission to care for themselves can make massive physical outcome improvement for NICU families.

And then we have the transition to home. So this is really where I do my own work as a NICU doula. And that's where the NICU translator started before even all of the podcasts and the training and everything. I was working one-on-one. took my experience as a NICU nurse, my training as a doula. If you want to hear my journey to that, you can go back to episode one. We'll link it in the show notes below where I talk about how, what this looks like for me. But I specialize in helping families transition from the NICU to home.

from going from that 24-7 nursing care, continuous monitoring, you look over your shoulder and say, hey, I've got a question and there's somebody there to help you think it through, to be like, here's your baby, you have a pediatrician appointment in 72 hours, but that's it. And that can feel so incredibly isolating and overwhelming. And oftentimes, again, people may want to help support their family member. Maybe it's a postpartum doula, but without NICU experience or a loved one.

but the NICU is really unique. NICU babies post discharge, especially preemies or babies that had a more complex day, their journey home is going to look very different. They may have unique feeding needs or sleep needs or their own experience and their own kind of quote baggage that they're bringing home from the NICU. The NICU doesn't just end at discharge. It's chapter one. The NICU is only the beginning, but life after NICU is chapter two and it can be a doozy for some families. So having a trained NICU doula be able to

help guide families, help support them again with the logistical and practical realities of having a baby at home and being freshly postpartum. And what does that feel like emotionally? What does that look like practically? Helping create systems and helping to deinstitutionalize from the rhythm of the NICU, which is very time strict and on care times and really rigid and really doesn't allow families to trust their gut and feel like they do know what's best for their babies.

And one of the things we talk about in NICU Doula Academy is how, you know, in the NICU families are following orders to a certain extent, right? During rounds, the physician, the care team decides on specific orders. The orders are written down and they almost become like law to a certain extent. You know, we are feeding X amount of milk, X amount of times a day. Here's the schedule times that we're doing that. And then the families go home and there's no attending physician. They are the boss and the captain.

of their baby's care. And they are integrating with the medical team, but it's very, very different than being in the inpatient NICU settings. And we often, as NICU providers, do not prepare families for that experience. We often a lot at discharge teaching in the NICU and discharge planning is to get the baby to discharge, and very little is done thinking through what that looks like beyond the NICU. And so families can feel incredibly overwhelmed.

So especially if you have a NICU doula that's trained in the full spectrum of NICU care, as certified NICU doulas are, especially graduates of NICU Doula Academy, they can create this continuity of care that NICU families are often lacking. And sometimes NICU families that have a more complex baby that's going home, maybe they're going home with extra tubes and wires and specialty appointments, sometimes those families actually can feel more supported because they qualify for all this additional support and resources and follow-up and appointments.

is oftentimes those in between NICU families, maybe they had a shorter stay, maybe they're, you know, like a 32, 34 week baby, they maybe were always that quote, healthiest baby in the NICU and always a feeder grower. That experience still changes what life after NICU feels like and their transition into independent parenting. But oftentimes the resources for these families is even more limited and really

let them feel even more left behind in.

Where do I fit in? I don't fit in in a mothering circle because all these people are telling me about their blissful, perfect birth and I'm really frustrated or maybe still sad. Or I don't want to scare people about my NICU journey. And also my baby has very unique feeding needs and they're on a corrected milestone plan because of their prematurity. having someone there that just gets it and can walk alongside family and offer presence and support and connecting with, again, local resources, support groups, peer support.

coaching, just feeling like someone's in your corner and listening to you, that is the power of a NICU Doula as they transition to home. So the impact is incredible and I am so excited to also be diving into and exploring

with the support of my graduates of NICU Doula Academy who are all over the world.

starting to bring this concept and this work and their unique background and skills and their unique passions to their communities literally all over the world. We have the NICU Doula academy graduates on several different continents at this point in countries. But so the experience of the NICU, people just intuitively know that there's a gap, especially families that have been through it and are looking back and saying like, you know, we made it through, we survived, but we certainly

did not thrive. And my vision and my mission for the work of the NICU Doula is to bring more joy and less trauma to the NICU experience, allow families to feel like parents, allow them to feel healed and seen and cared for so that they can care for their babies. And the potential for the long-term impact that this might have is really unlimited. I'm excited to be working behind the scenes on some research projects and partnering with medical institutions to

really start to explore the potential impact. And we know that oftentimes change comes from data. I am a huge proponent of evidence-based practice. And there are many resources that bring all these concepts together, but I am really passionate about bringing this role of a NICU doula doing it right. So making sure that the people are stepping into this role and feeling that like they have their knowledge and skills and support themselves to be able to support families.

in this incredibly unique and deeply deeply needed role. So if you are a doula or a birth professional, a NICU nurse, a NICU family, and this is like kind of like boop boop, like bobbing off some white pops in your head, the NICU Doula Academy is the first NICU doula certification program. It is a 10 week live cohort based.

⁓ Training program that offers 30 hours of nursing CEs through AHNA which is the American Holistic Nurses Association and I built it because I was doing this work myself ⁓ And I knew that I can only support so many families and there's so many people that have such a passion for this this type of I Guess revolution and mission and impact that just sometimes needed

gaps filled in their own understanding and their own training and their own experience. So we've had three cohorts of NICU Doula Academy go through. Actually, we're midway through the third cohort at this point. And so I have grads already out in the world doing some incredible work. We've already in this podcast talked to Shayna and Jillian and we'll link their episodes below that are using their NICU Doula training in really unique ways, again, that are

directly tied to how they want to make an impact on the NICU experience in their local communities. And in future episodes, we're going to continue to highlight more NICU doulas that are graduating through this program. I also am in the works of building a NICU Doula directory, which is going to be a hub for families who are seeking NICU Doula support, for professionals who are looking to connect with people in their community that maybe are helping to fill.

gaps for their own client work, for hospitals and healthcare systems looking for this type of professional to be able to safely and competently step into this role so that everybody can kind of find each other and we're gonna continue to build and fill in these gaps, ⁓ especially as healthcare continues to change and evolve the need for this emotional and practical support and the role of the NICU doula of this non-medical.

professional who can walk alongside and integrate within the medical team, not from a place of competition or conflict, but from a place of true collaboration and being on team baby first and foremost and being able to really make this incredible tweak and change and support everybody in the NICU, the families, the babies, the healthcare providers, the doulas. If we all kind of remember our shared mission and our shared values and our why, like we all are there to help support.

really the babies and inadvertently in the families and allow them to thrive and not just survive the NICU experience. So if you're interested in exploring this, maybe you are a doula who already is serving in birth or postpartum work, but really wants to better understand and be able to support or maybe even specialize in NICU support. Maybe you're a NICU nurse like myself who knows

the pathophysiology and the medical care of Niki babies, but maybe is feeling less confident in their trauma-informed care approach and how to help support family's life after discharge. One of the things that I really hone in on NICU Doula Academy is that this is a community. So it's not just a class and you watch the videos and you check a box. There are videos and you do watch them, but we also have community and chat.

and alumni groups and live calls and we're doing case studies and we're talking to each other and we're learning from each other's experiences. Each co-worker thus far has had an incredibly unique flavor and it's because of who's in that space. We have nurses, we have NICU families, have doulas, have lactation consultants, we have mental health licensed therapists, we have had so many interesting people, people working in nonprofit work, newborn care specialists, nannies, the...

NICU touches lives in so many ways and there's such a unique need for this type of training. One of the other things we do in NICU Doula Academy is not just the content and the community and the support, but we also build in like, how do we do the thing? Right? Like, okay, now I know how to be NICU Doula. How do I be at NICU Doula? So we have two final modules that are all about networking and integrating into your healthcare system. that's something we do. Starting your own business. This is incredibly...

when I was a NICU nurse and trying to figure out how to be a NICU doula, that was a steep learning curve. And so I'm taking all of my years of experience and knowledge and training and putting it in one spot so you don't have to struggle to figure out, okay, maybe I do want to do what Mary's doing and I want to be a NICU doula using my NICU nursing skills, but in a very unique way, it's in there for you. And oftentimes we often have NICU families who do not have medical or doula background, but know that their NICU experience makes them so...

prepared to be able to support and truly understand what these NICU families are going through, but understanding and wanting their own knowledge filled in other NICU experiences. So maybe they're a preemie family and they want to better understand the term family's experience or what lactation support might look like. Or maybe they are looking to have more of that holistic doula lens and trauma informed care language and postpartum physical support and nutrition. So people are going into NICU Doula Academy with different

Again, we bring in our stories and our experiences. We meld them all together in this incredibly powerful cohort. We take the knowledge and training that was missing from our own experience, and then we come out of it on the other side, like amped and ready to do the work. So if you're interested, I am just about to announce the dates for the 2026 cohorts. We're going to have three live cohorts coming up. So if you're interested, make sure you are on the wait list. The link will be in the show notes, or you can go to...

the NICUTranslator.com slash NICU dash doula dash Academy. And all the information about the program is there, the cost FAQs and the wait list. So even if you're like, maybe, I don't know, I always open the cohorts to the wait list first. historically they've almost filled up entirely from the wait list. We try to keep the cohorts in a manageable size so everyone can have that unique experience and really get to know each other and build those true relationships and networks.

And I do offer it at a lower price to the wait list as well. You get first access and a discount. So make sure you are on the wait list. It's not a commitment, just means that you wanna know, be the first to know when things go live. And if you are also interested in this, I'm going to have some workshops coming up that's talking a little bit more about NICU Doula work and NICU Doula training. You can always email me, hello at the nicu-translator.com, send me a DM on Instagram, I'm at the nicu-translator.

And I just have loved, truly loved doing this work, bringing, building up a generation of, really a network and an army almost, of NICU doulas and NICU informed doulas who are going to create this new model of holistic, integrative, supportive NICU care that benefits everybody involved. And the potential for this

gives me the chills every time I think about it or talk about it. And it's really because of the people that I meet and being just in a space in the NICU Doula Academy with other people who shares the similar mission. I just can't wait. I can't wait to see. And I would love to have you, dear listener, as they say in Bridgerton, a part of this 2026. It's just gonna keep getting growing and getting bigger and better. We're have more and more alumni options.

⁓ More outcomes, more networking, more support. I'm going to start bringing this work out into the medical community even more so and go on a conference circuit, do all the things. So you are going to be at the forefront of this revolution alongside me and your other NICU Doula cohort grads. And ⁓ I can't wait to see you all there.