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Medical science has already made great strides. Now, it is most important for NICUs to turn their focus to the human side of the work to help preemies and families thrive beyond their time in the NICU.

Dana had already given birth two two healthy children, so when she got pregnant again, she thought that she was prepared for the road ahead. A "veteran", even. This time was different, though. First, Dana was warned that her placenta was "dangerously low lying". Her next prenatal visit confirmed placenta previa — a condition in which the uterus fully covers the cervix, making vaginal birth deadly for the infant and life-threatening for the mother. 

Dana would have to have a scheduled c-section before her due date to protect her and her unborn son, she was told. Again, things did not go according to plan. When Dana unexpectedly went into labor at 31 weeks, she was rushed to the hospital in an ambulance, sirens blazing, and had an emergency c-section under general anesthesia. 

When she woke up, her son was gone — taken to a hospital with better NICU facilities. She wouldn't be able to meet him until a week later. Even then, the visits were short and clinical. Dana pumped milk at home, took the bus to the NICU, dropped it off, and got a glance here and there at her baby. No touching allowed.

Dana and her son were just two out of many. Every year in the United States, one in 10 babies are born prematurely, amounting to a total of 380,000. Neonatal Intensive Care Units around the country work hard to give these babies a fighting chance. Whereas being born at 24 weeks would once have been a death sentence, even these "micropreemies" can now potentially survive. The life of preemies starts, however, with struggle. Their risk of long-term complications is high, and increases with each extra week they should have stayed in the womb.

How does the environment of the NICU impact the neonate and their family — and what can be done to improve their lives?

The NICU Experience

Prematurely born babies have much higher odds of suffering long-term health problems like cerebral palsy, chronic lung disease, hearing loss, blindness, and intellectual disabilities (premature babies show less interest in people, an indication of neurological changes). Even late premature babies have a different brain structure than infants born at term, research has shown, and they are born between 34 and 35 weeks into a pregnancy. 

These complications are inherent to the fact that these babies were born too fragile and too soon, but studies have also made it clear that stress harms the development of premature babies. The environment of the NICU can either actively give preemies the best possible odds, or fail to do that. 

Families, and especially mothers, meanwhile, enter the environment of the NICU having faced a traumatic experience — a dangerous birth and conditions that cause them to fear for their newborn's life. Both postpartum depression and post-traumatic stress experience are common. The clinical environment of the NICU can help families bond with their infants, as they feel supported and cared for, or it can fail to do that. 

What Can Be Done to Make NICUs better?

Five separate factors influence the wellbeing of premature babies and their families during their stay in the NICU, a study entitled The Neonatal Intensive Care Unit: Environmental Stressors and Supports has found.

The first of these factors is the quality of communication with the staff at the NICU, as well as the frequency of that communication. This might appear to speak for itself, but former NICU mothers reported increased wellbeing when the staff told them exactly how their baby was doing, and what kind of medical procedures they were having. Caring communication, in which nurses took the time to sit down with mothers, was especially valuable. 

Families who weren't fully informed and who had no idea how their babies were doing suffered, on the other hand.

The second factor was the staff's bedside manner. Families who had poor experiences — including things like being criticized for not making enough breast milk! — experienced increased stress, while those who had caring experiences with staff felt reassured and more confident.

The third factor was feeling alienated from the newborn's care. Babies in the NICU depend on professional and skilled care, but parents who feel like helpless bystanders as they can't even change a diaper or, in some cases, give their baby a kiss. Involving families as much as possible doesn't only help parents feel better, it also promotes infant/parent bonding and increases the wellbeing of the preemies who are being cared for in the NICU. NICUs who make it possible for parents to participate in care tasks are taking a giant leap in the right direction. 

The fourth important factor is support from other NICU parents. If you ever find yourself with a baby in the NICU, talk to other moms and dads, form a support group, and agree to check in on each other's babies. This support can be invaluable. 

Finally, the NICU's physical environment and its rules also matter a great deal. Yes, at-risk infants are being cared for in NICUs, which are by definition a clinical environment. However, both families and babies fare better if they get the chance to bond early on. A warmer physical environment that's less scary (and makes parents think "doom thoughts" less often) can be helpful. More important, however, is that the NICU allows more family members to visit the preemie, that parents can visit whenever they like, and not just during visiting hours, and that one-on-one time is facilitated wherever possible. 

Medical science has already made great strides. Premature babies have a better chance than ever before, thanks to medical science, and in some cases, progesterone treatment can prevent premature birth. Now, it is most important for NICUs to turn their focus to the human side of the work to help preemies and families thrive beyond their time in the NICU.

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