The NICU Translated Podcast

Mary Farrelly (00:00)
When your baby is admitted to the NICU, you enter a whole new world, one filled with medical jargon, beeping machines, and unfamiliar routines. It's a world that can feel overwhelming and intimidating, even for seasoned birth professionals. That's why today we're going back to the basics with the NICU 101 Crash Course, breaking down what is the NICU, who's on your baby's care team, and a few key terms and concepts that will help you feel more confident from day one.

Hi everybody, welcome back to the NICU Translated Podcast. Today I'm so excited to dive into a crash course in everything you need to know about the NICU. This is something that I wish every single pregnant person and person that supports pregnant people knew about the NICU because the NICU is so often left out of prenatal conversations, whether it's childbirth prep classes, talks with your doulas, talks with your OB or midwife.

If anything, the NICU is just like, you know, and we have one, not why would you need one and what might happen when you're there? So today's topic is really just going to hone in on the basics. And in future episodes, we're going to go deeper on some of these topics. But I wanted to have a place for you guys to start and just really have a core understanding of those key concepts of what a NICU is and the work that happens in that space. So the NICU is part of your birth story or the story of someone you're supporting.

you feel a little bit more confident to step in and enter into the space from a place of informed decision-making and empowered parenting instead of trauma and overwhelm. So let's start at the very beginning. What is the NICU? By definition, the NICU stands for neonatal intensive care unit. The medical definition of neonatal is a baby that's born and is less than 30 days

babies can stay in the NICU for a variety of length of time, from a few hours to a few days to a few weeks, months. And I've even celebrated first birthdays in the NICU before, although that is quite rare. The ICU part of NICU stands for Intensive Care Unit. So the NICU is by definition a really highly medicalized intensive care unit. A lot of the same equipment.

tools, medications that is used on adults in an adult ICU is also used in a slightly different way, but with the same level of intensity that is happening in adult ICU can also happen in a NICU. So a common myth that I hear is, you know, that the NICU is all sunshine and rainbows, but the NICU is a place where really impressive and intensive medical care is being delivered to extremely preterm or critically ill term infants.

One thing that I wish more people knew about the NICU is that there are multiple different levels of NICU care. I'm in the United States, and so I'm going to speak specifically about levels of care in the US, but in most NICU models and healthcare models abroad, a similar model exists too. So at the very kind of basic level of NICU care is called Level 1 NICU. So any hospital that has a labor and delivery unit

has the capacity to offer level one NICU care. But typically a level one NICU, also known just as a well baby nursery, does not physically have a space where babies can stay. So it typically just means that there's somebody on staff that is trained to be able to resuscitate and stabilize newborns that need additional support, but that if the baby needs additional medical care, they will need to be transferred to a different facility. A level two NICU,

is often also sometimes known as a special care nursery. These nurseries are typically staffed and have the equipment and training to be able to care for babies as young as 34 weeks gestational age ⁓ that don't really need a lot of additional complex medical support. So they might need some time feeding, learning how to feed by breast or bottle and growing. So some of these babies might need to be in an incubator,

have a feeding tube, need a little bit of support, but they don't also still need complex medical treatment like respiratory support, IV medication, surgery, anything like that. Those babies or any babies born at these healthcare facilities that is less than 34 weeks will need to be transferred to a different level of care. So the next level up is level three. And this is your typical, what you think of a NICU, most of them are going to be level three NICUs.

Level 3 NICUs can care for incredibly fragile, tiny, low-birth-weight babies down to 22 weeks gestation in some instances, all the way through term infants that need complex support. So they can do ventilators, they can do some different types of surgery. The NICU team is highly specialized in caring for the complex medical needs and the unique needs that NICU patients have.

But there are some instances in which a baby is more complex or needs a higher level of care. So they would then need to be transferred to a level four NICU. So level four NICUs tend to be the more regional NICUs. They're usually, but not always, associated with a children's hospital or academic medical facility. And the biggest difference with a level four is that it has all the pediatric specialists in house.

So if the baby needed to be seen by pediatric cardiologists for a problem with their heart, there would be somebody there. If they need to be seen by a pediatric nephrologist, so a pediatric doctor who specializes in kidney health and kidney disease, they would be there too. Whereas in a level three, the specialist may not be able to visit or maybe they come every once in a while. It doesn't have the same access to 24-7 complex medical care. And there are sometimes some procedures

surgeries, specialized diagnoses that would need to be seen by a level four NICU too. So when you are planning on where you're going to be delivering your baby, the one thing that I wish every person knew is what are the different levels of care in my area? So you might know that the hospital you're delivering at has a NICU, but you might not know whether it's a level two, three or four. So that can help just guide your decision and maybe some contingency planning.

that you might be thinking through ⁓ when you're considering what your birth journey is and what your vision for that is as well. The length of stay for a NICU stay can range anywhere from four hours for observation, again, up to that one year or more, but the average length of stay ⁓ is about 15-ish days, but that is the average. So again, that takes those babies that are there for months and months and that were born extremely premature, very sick.

and those babies that just need a little bit of additional observation. One of the other things that you're going to see if the NICU is part of your journey is there are lot of different faces and people that you're gonna be meeting in a NICU environment. The first person that you would likely meet is a NICU nurse. So NICU nurses are specially trained to be able to care for these critically ill and extra tiny fragile babies. And typically in the NICU, you'll have a nurse that will have

one, two, three, or sometimes four babies that they're caring for during their shift. You're also going to meet other professionals like the neonatologist, which is likely going to be the doctor that is guiding the medical decisions on your baby's care team. Some hospitals, whether you're associated with a teaching hospital or academic hospital, you might have different levels of doctors. You might be interacting with a resident or a fellow or the neonatologist directly, which would also be known as the attending physician.

and they are all medical doctors, so they've all finished their medical school and have their medical degree, but they're in different stages of their post-medical training journey. So some are really honing in on becoming a specialist in neonatal care, and others are spending time in the NICU to further advance their own vision for where their career is gonna take them, which may not necessarily be the NICU. There's also a lot of additional support professionals that work really closely with the doctors and the nurses.

A lot of NICUs have neonatal nurse practitioners, otherwise known as NNPs, which are registered nurses that have a master's degree that specializes in care of NICU babies. Well, there are also some NICUs have physicians assistants or PAs that are also specialized in NICU care and that do a lot of the bedside procedures and hands on kind of those more complex bedside medical procedures.

in addition to helping support families and the medical team with making decisions and implementing plans of care. You're also gonna see a lot of other specialists like respiratory therapists, also known as RTs. These professionals work really closely with the nurses in managing the baby's breathing support. in the NICU, there's lots of different types of breathing support, depending on how little the baby is and what's going on with their lungs. And so the RT and the RN work really closely together along with the medical team.

to constantly be tweaking and changing the different types of respiratory support to meet that baby's unique needs for that day. You're also likely going to be able to meet with a lactation consultant. Oftentimes this is an IBCLC. ⁓ Many NICUs, especially level three, level four, will have NICU specific lactation consultants who are really ⁓ deeply understanding the unique journey of a breastfeeding experience for a NICU family.

you're also likely going to meet a lot of developmental specialists. So a lot of the development that would be happening inside a belly for a preemie is also then going to be happening outside of the belly in the NICU. And there's a whole team of professionals that are experts in how to support that type of care. So you might meet an OT or occupational therapist, PT or physical therapist, or even an SLP, which is a speech language pathologist. And they all work on different parts of

the baby's systems that allow them to grow and develop and get ready for discharge and beyond. You're also likely going to

of several social workers or case managers. These people are there to help you navigate the logistics of NICU care. So whether it's managing housing, food, dealing with medical equipment after discharge, all those different like practical things that come with navigating a NICU stay.

But the most important person on the NICU Care team is the parent, is the person who created this tiny human and is ultimately going to be the one taking these babies home. So even though it can feel like the NICU is really overwhelming and that there's all these people like those that we mentioned that know so much

have expertise on NICU care.

At the end of the day, the family is the expert on that baby and how they want their life with their child to look. it can feel like you're, a parent sometimes, don't always have as loud of a voice in the NICU. In future episodes, we're gonna dive deeply into how to be an empowered advocate for your child in the NICU setting. But just know now that parents are just as important as the doctors, nurses, and all the other specialists.

in making sure that that baby gets the individualized care that that unique baby needs in that moment. The other thing you're gonna notice when you look, come into the NICU is there's kind of a whole nother language that's being spoke. There's a lot of acronyms. You might hear words being tossed around like CPAP and RDS and Brady's and DSATs and NGs and OGs and TPN and all these different alphabet soup of what's going on in the NICU.

In future episodes, the NICU Translated episodes, we're going to go in depth and short, bite-sized episodes that really help you understand each of these individual pieces of equipment, diagnoses, acronyms, so that you can feel more confident ⁓ really sitting in on rounds and understanding what's being said. But.

For now, it's helpful to know kind of maybe what sights and smells and sensations you might feel as you walk into a NICU setting. There are two different main models or types of kind of layouts for NICUs.

Some NICUs are in an open bay setting. So that means that there are lots of babies kind of in one big room. There are some privacy screens to separate, but the doctors and nurses are really caring for all the babies in one open bay setting. Other NICUs may have private rooms. So the baby will be in the room and the doctors and nurses will be able to monitor that baby's vital signs remotely and then go in for.

the hands-on care as the baby needs it. So depending on how the NICU that you will be going to is set up will dictate how you can change and adjust the physical space, including whether or not you are able to safely spend the night with the baby. So that is another thing when you're doing some birth planning or thinking through different options is to maybe ask and see what the setup of the NICU is that

you would go to if the NICU were part of your birth story. And then also know that each NICU is likely going to also have its own kind of flavor for different rules and policies that are in place, especially around visitation and who can come in the NICU and maybe the hours of the day that that's allowed. So when you're walking into the NICU for the first time, you're likely going to get a kind of rundown from the bedside nurse.

about the policies that are related to visitation. Most NICUs will allow parents or the care partners, so the medical decision makers for the baby, to have access 24-7 to the baby's bedside to be able to be there and really get to know the baby's needs and be a present part of the care team. But the logistics of that are going to look slightly different for each NICU, and a lot of that's gonna depend on the layout of the NICU.

staffing and different kind of culture changes there too. So if the NICU is part of your birth story, the first thing to do is to realize that you're not alone and there are a whole community of people who have walked this journey before you and another whole community of people who are committed to walk this journey alongside you. So it can feel incredibly overwhelming, but being able to connect with people who are trained and

able to be able to support you through this can make a world of difference for navigating those early, especially those early hours and days in a NICU setting. Some things to do just kind of get oriented to the baby's bedside is to start out again, assuming that your body and your mental health is in a space to accept knowledge and understanding because after giving birth to a baby, especially if it was, you know, a major surgery or you're still recovering physically yourself, you might not be in a place to

learn and to retain information and that's okay. It's okay to say, I'm pretty sure you told me this information yesterday. Can you repeat it to me again today? That's okay. But one of the first things that can be helpful is to get a tour of the baby's space. So usually that would look like the bedside nurse sitting alongside you and kind of pointing out what are the different numbers? What are the different stickers that are on your baby? What's the different equipment and what do they all mean? Which are those alarms that are like, those are nice to know.

versus which of the alarms are like, okay, people are gonna be coming to my bedside now. Because there are a lot of, there's a lot of alarms in the NICU, a lot of different noises and beeping. And especially as someone who's never set foot in the NICU before, they all sound like a crisis and an emergency, and that can feel really, really overwhelming. So it can be helpful just to ask, what are those noises that I need to be worried about? I usually say to my families at the bedside, if no one's running to your bedside right away,

It's likely not an emergent alarm, but if you're worried, definitely let me know and I will come to you. The other thing to start to get to know in the NICU is your baby's care time or schedule. So most babies in the NICU are on a every three hour or every four hour. You might hear it said Q3 or Q4, which is nurse speak for every three or every four.

In the NICU, we really focus on clustering cares, which can help promote that neuroprotection and developmental, that really therapeutic sleep time and rest time in between cares. So on a care time is really when we're going into the baby's space, whether it be an isolette radiant warmer, a crib and interacting with them. So changing their diaper, taking their temperature, repositioning if they're stable enough to have a feed, that's when we would do the feeding. So it can be really helpful to know in those early days.

what is your baby's care schedule? Usually it's gonna be like an eight, 11, two, five, or nine, 12, three, six, and this is 24, seven, around the clock, because babies don't care whether it's day or night. So once you know that the baby's routine, you can kind of start to envision your own routine as a parent. How, if pumping is part of your journey, how you might fit in pumping, how you might fit in your own rest, in your own postpartum care and support. So.

being able to know that baby schedule, can start to build out your own. Also, it's essential in the early days to figure out how and when to communicate with your NICU team. As I mentioned before, NICU nurses are caring for usually two, three babies at a time, sometimes one-on-one, sometimes more. But the different providers like the doctors, nurse practitioners, physicians assistants, therapists, they're seeing multiple patients during a day.

So it can be helpful to know when is rounds. Typically rounds happen once or twice a day and that's when all the people get together in one spot and talk about the plan of care for the next 12 or 24 hours. So as a parent, it can be really helpful to know when are those conversations happening and how can you ensure that either you're there or if you can't be there, how would you like to be updated with? How do you know who your doctor is for the day? Is there a whiteboard that's communicating this information?

Is there phone number that you can call? Do you need a special password to be able to be brought back on the phone to the nurse? Just having an understanding of the basic logistics can be really helpful in those early days too. And then keeping some sort of a journal is incredibly helpful. As I mentioned before, when you're freshly postpartum, information typically goes in one, I used to joke when I was pumping and breastfeeding that all my...

information would come in my ear and go right out in my breast milk ⁓ Which is funny, but also felt very true Like you just I felt like I couldn't retain as much information even though I wanted to so having some sort of Place that you can write down your questions your concerns your thoughts You know you're pumping at two o'clock in the morning and you think of a question you want to ask on rounds It could be an app in your phone. It could be a tangible resource. There's some really amazing options out there I can send put some links down below

in the show notes that you can explore if the NICU is part of your journey and you're looking for a journal or it can just be a plain old journal. And if you're looking for a gift to give a family in the NICU journey, this is a great option. It ends up being in the long run, in the short term, it's a place to keep track of your thoughts and the who's who, what's what of the day. In the long term, it becomes a keepsake where you're really able to look back and see your baby's story and your journey.

and then able to tell that story back to your child someday. Because it's part of their story as much as it is ours as parents. And then remembering throughout all of this that you are not a burden, you are a gift to your baby. There's a magic that you and only you as a parent can give to your child. There is a healing and a nurturing and a connection that the medical care team simply cannot do. We are

excellently trained to be able to meet the nutritional needs and the physical needs and understand and treat any infections or anything going on that is medically challenging in the body, but the nurturing and the parenting, the essentialness of being a human is really, that's the magic of a family. So you are allowed to ask for something to be explained as many times as you need. You're allowed to participate in your baby's care. You do not need to ask permission to do so.

and this is your baby and you belong in their story. I hope this is a quick, easy way to be able to understand the NICU, just the basics, just enough that you have, ⁓ maybe if the NICU becomes part of your journey, you can reflect on this episode and say, okay, I've got this. I know the basics, I know who's who, and in the episodes to come, we'll be able to go deeper onto different topics.

and meet different people and different experts in different areas so that we can continue to build our NICU knowledge and confidence together. If you are a pregnant person or doula and you are looking for ways to incorporate the NICU into your prenatal planning or conversations, which is something that I am deeply passionate about, I feel like the deer in headlights look that I see on most of my NICU families as they come to the bedside is really a result of total

not understanding whatsoever that the NICU could be part of their journey. But the reality is that most NICU admissions are unexpected. Some families do know prenatally that this is my or is like is definitely or likely going to be part of their NICU story. But for many families, it's extremely unexpected. With this in mind, I created a free template called the NICU Birth Plan Template. It's a PDF and a canva link that you can edit yourself.

that has a series of questions that you as a family can walk through, or if you're a support professional like a doula, you can walk your families through so that they can have a better understanding of their preferences and unique needs as related to a NICU. Because oftentimes we prepare so much for birth, maybe we prepare for postpartum, we know what decisions we wanna make, we know how to advocate for ourselves in those scenarios, but we never talk about the NICU. So that feeling of helplessness and lack of power.

really related to lack of understanding and confidence in our own knowledge can create those feelings of overwhelm and trauma. So even by planning just a little bit for the NICU, by going through a birth plan template, it can help ease those feelings.

it's completely free. I will drop the link in the show notes below. ⁓ And I hope that going forward, everyone will have a prenatal conversation about the NICU, not from a place of fear.

but from that place of empowered and informed decision-making. So to kind of close up for today, the NICU can certainly be an incredibly overwhelming place at first, but the more you understand it, the more empowered you'll feel. And you don't have to memorize every term or know every piece of equipment today. We can just start with the basics and let your confidence grow from there. And remember that the NICU is only the beginning. It's only chapter one, and you are a vital and essential part of your baby's care team.

That's it for today and we'll see you in the next episode. NICU you love, Mary.