Scott Webb (Host): Becoming a parent is a joyous time, but when newborns have to be admitted to the NICU, parents are rarely prepared for this and often have more questions than answers. Joining me today to discuss why family care at the Elliot NICU is such a high priority is Dr. Katherine Redford. She's a pediatrician specializing in neonatal and perinatal medicine with the Elliot. 

Scott Webb (Host): This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Dr. Redford, it's so nice to have you here today. We're essentially going to talk about family care in the NICU and what that means, right? So, let's start here. Why is caring for the family of an infant in the NICU prioritized at the Elliot?     

Katherine Redford, DO: So, we know at the Elliot and our NICU that when we're taking care of a baby, we know we're really taking care of the whole family, right? The parents are the most important members of our care team. We want them to feel involved in the care of their babies, and we want to make sure they're feeling heard and understood and that any concerns they're having are addressed.

We want to make sure they feel comfortable with the plan that we have for the baby, and at the same time, we know most parents don't really expect to come to the NICU when their baby is born, and it can be sort of an unexpected challenge and sometimes a heartbreaking situation for families. So, we know it's important to support the parents as much as we're supporting the babies, and the research really shows that family-centered care provides the best outcomes for babies that get admitted to the NICU.

But more than that, it's also sort of just our nature as pediatricians. Every neonatologist is a pediatrician by training and we choose this field because we love taking care of children and taking care of babies, but also because we love taking care of the whole family.

Host: Yeah, I love any chance I get to speak with pediatricians. My kids are older now, so I miss the days of going to the pediatricians. There's just a different way that you all interact with parents and kids. And as you say, no one expects to go to the NICU, so it can be surprising and shocking and all that that implies. So, let's talk about the supports that are available for families and infants in the NICU.

Katherine Redford, DO: So, we have in our NICU, we're very lucky. We have a full-time social worker who supports our unit. She's really an amazing resource for our families because they're often navigating a really complex NICU admission, planning for what can sometimes be a very unexpected and prolonged hospital stay.

So, she meets every family when they're admitted to the NICU, supports them throughout their stay, and helps them with whatever they need. And then we also have in our unit, and our social worker is a part of this committee, but what's called our NICU Family Support Committee. It's an interdisciplinary group of providers, nurses, our therapists, our social worker.

We also get input from former parents and look for ways to continuously improve the experience of a NICU stay and figure out ways to help parents through that process. So, we provide educational sessions on topics pertaining to the babies in our NICU. We have support meetings for parents and provide them with materials that can help them as they move through their stay in the NICU.

Host: Yeah, and I'm sure that's a real comfort to families that are going through this to be able to speak with and have access to folks who've been through this before, just to put their minds at ease and to help them through this process and understand what's going to happen and when and how and all of that and along those lines, you know, how are families kept informed about their infant's condition and progress.

Katherine Redford, DO: Exactly. So, absolutely, we want to make sure that parents feel very up-to-date on what's happening with their babies in real-time. Our provider team is always providing in-person updates to parents as soon as they visit during the day. And, of course, we have an overnight team that's always available to talk with parents who visit in the late evenings. 

We also invite parents to attend rounds and hear from the entire team. And we really do have a big team in the NICU. We have respiratory therapists, nutritionists, pharmacists, the whole gamut, and so they get to meet the whole team and see all the people who are helping to make plans for their babies. 

And of course, you know, sometimes NICU parents are waking up at two in the morning from home with questions. And so, we invite them to call anytime they just want an update or to be reassured that their baby's doing well. So, we make sure that parents feel a part of the care and are informed and updated every step of the way.

Host: That's great. Like I said, my kids are older, but I remember that period of time. They weren't in the NICU, thankfully, but that period of time after they were born, before I actually got to hold them, you know, and just standing there at the glass, you know, wanting to hold my babies. I do know how important bonding and attachment are to get that started as soon as possible, which can be difficult, of course, for kids who are in the NICU. So, how do you work on that? How do you work through that, in the NICU, to support bonding and attachment between the parents and infant, with everything that's going on, I guess?

Katherine Redford, DO: Right. And you're right that parents think about that and dream about that moment from the moment they find out they're expecting. And so, when a baby gets taken to the NICU unexpectedly, it can be really hard for parents. But we really try as a team to make sure that we're prioritizing bonding and attachment between parents and their babies.

So, we encourage parents to learn supportive touch for our very sick babies from the beginning and to participate in diaper changes very early on. Doing this really helps them to begin to feel more secure in their role as parents when their babies are very sick. And we also prioritize babies that can do it, which is most babies in the NICU, that they can do skin-to-skin.

We know it's very beneficial to even the most premature babies. And so, whenever it's safe to do so, we encourage parents to do it. Parents are sometimes understandably nervous, especially if their baby is extremely premature. But our nurses are really experts at helping parents feel more comfortable, explaining the steps of holding, and showing parents how mutually beneficial skin-to-skin can be.

And we also have an amazing therapy staff. We have occupational therapists and physical therapists, and they see a lot of our babies, and they love getting the parents involved in the care that they provide. So, they'll often teach infant massage and developmentally appropriate ways to interact with the babies.

So, we really try to get them involved as part of our care team and sort of give them helpful tricks about what makes their baby have slightly different needs as compared to a baby who's in the well-baby nursery. But we want to make sure that they're getting every opportunity they can to be hands-on and connected with their child.

Host: Sure. And I'm sure along those lines, we're talking about families, of course, the needs of siblings and other family members. So how do you sort of involve them and communicate with them and make them feel a part of things?

Katherine Redford, DO: Yeah, so it's very tricky in the NICU because we have to restrict visitors to prevent the spread of illness because the babies in our care are very fragile. But we know that behind the parents who are able to visit 24/7, there's a village of other family members standing behind them and worrying about this baby that they most likely haven't yet met.

So, for parents who have older children, we encourage them to sort of find the balance that works best for their families because a lot of times they're here in the NICU for a long time, and so they're feeling torn in two separate directions with their older children and then their child that's with us for a prolonged hospital stay.

So, we encourage parents to bring in favorite books from home or photos of the older siblings, and then they can use those to sort of personalize their baby's room and take photos and videos there, and bringing those home to the older children can really help them to feel like they are stepping into a big sibling role if they're old enough to understand it.

So, while we can't have the whole extended family visit the babies, we want to make sure that they still feel included and part of the family.

Host: Sure. How about the accommodations for families that need to stay close to their infant in the NICU?

Katherine Redford, DO: Yes, so our parents are welcome 24/7 in the NICU. We have no visiting hours. We tell them you are a part of this team, you be here as much as you want to be. Some parents really do feel comfortable being at their baby's bedside from the beginning of the stay to the end. So, when that happens, we have small beds.

They're a little bit nicer than a typical cot, so they're a little bit more comfortable, that we can put them in the baby's room for parents that are staying the night, some parents use those every night, others tend to use them as the babies are beginning to work on feeding and working on breastfeeding as they approach going home. So, we're able to accommodate families staying 24/7 with their babies.

Host: Yeah, and as we sort of prefaced today, you know, the visits, the stay in the NICU is often unexpected, and you mentioned that there's a plan, of course. So, I just want to talk a little bit about how you involve families in the decision making about their infant's care.

Katherine Redford, DO: So, we always want to make sure that parents feel very much included and part of the care plan because they know their baby best, and they have in mind what they think is best for their baby. And so, we want to prioritize that. We want to make sure we're paying close attention to what their short-term and long-term goals are for their baby.

And similarly, we want to share our goals with them. So, we want to hear any worries that they're having, what their family values are, and what their hopes are, so that all of the care that we're providing is in keeping with that. By keeping the lines of communication open between the care team and the family, we can work together to figure out how to best support the baby and figure out what the next care steps are.

Host: Right, because everybody involved from the families through the doctors and nurses and physical therapists and everybody, wants the same outcome. Which, of course, is for these happy, healthy babies to go home to their homes, perhaps to their siblings and pets and things like that. So, let's just finish up here today and talk about the support that's available for families that are transitioning from the NICU to home. Maybe the support even beyond that.

Katherine Redford, DO: We always try to make sure that parents feel ready to take their baby home. It's really a joyful, wonderful experience for them, but it can also be nerve-wracking, especially if they are with us for many days or even weeks and months. So, as soon as we know a baby's getting close to being ready to go home, our nursing team and our provider team will begin to focus on discharge teaching.

We try to figure out where the parents are at with their comfort level with newborn care and what it is they'd like to learn more about or have some extra teaching and tips and tricks from our team before going home so we can tailor the discharge preparation to the family. And once our patients are out the door, the support doesn't end there.

We make sure that every baby that leaves our NICU is set up with all the follow up care that they need with their pediatrician, any referrals to pediatric sub-specialists that they need, or early intervention services. And then, for babies who are born very prematurely, or those who are at higher risk for challenges with their development in the long term, we have our NICU follow-up clinic.

It's an amazing clinic where parents get nutritional support and developmental support and see the neonatologist after discharge. And we'll typically see babies every six months until they're two years old, or if they're no longer needing us before then. And that's just a wonderful time for us to see our patients growing and thriving and seeing how they're doing with their parents at home after they leave our NICU.

Host: That's great. Well, as I said, I just love speaking with pediatricians, you know, all medical professionals are great and awesome, and we need more of them, but it just, in my experience, you know, pediatricians just seem to have the biggest hearts, the best way of explaining things and with respect to the NICU at the Elliot and all of the assistance and support, both during the stay and after it's just amazing. So, thank you so much.

Katherine Redford, DO: Thank you so much for having me today.

Host: And for more information, go to elliothospital.org/NICU. If you enjoyed this podcast, please be sure to tell a friend and share it on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.