Building connections through separation: challenges in neonatal nursing

This week World Prematurity Day (17th November) sought to raise awareness of the impact that premature birth has on professionals and babies. In recognition of the additional challenges that COVID-19 has brought, this year’s theme was ‘Zero Separation – Act now!’. In this week’s blog Taslima Choudhury, a neonatal intensive care nurse and Birmingham Women and Children’s Hospital, reflects upon this theme in the context of her own experience.

The mother: a baby’s first home. A place where they are enclosed in warmth, darkness, and the softness of their parent’s voices and lullabies. With the fear of birth comes the adventure of a baby’s second home: enveloped in their parent’s arms, surrounded by their safety and closeness, at all times. And yet with the start of 2020, this journey looked incredibly different. COVID-19 threw us and our babies into unprecedented times. Aspects of neonatal care we hold precious were stolen from us; kangaroo care, breastfeeding and expressing, and planning baby’s care with parents as opposed to without. Where we stressed the importance of parental involvement and family-centred care usually, we were now creating barriers, stopping our parents from visiting for fear of worsening the pandemic we had already been drowning in.

From there rose the one thing all of us across neonatology advocate against: separation. We, and the world, focused so much on the stressors of coronavirus that we created stress for our babies by taking away their entire world: their parents; and it was daunting for us too! Separating mum’s and babies took us completely out of our comfort zone because now the concept of bonding looked different; now we had to adapt in keeping our families together without keeping them together. We really tried, despite the pressures of the pandemic and despite us reaching our limits, I witnessed my colleagues go above and beyond for our families.

When parents were allowed to visit together for short periods of time, we valued those moments by encouraging kangaroo care, changing nappies and feeding baby so that they spent time bonding together, caring for their little one… together. We invested in iPads and tablets so we could video call and send pictures to parents isolating at home or those inpatient at hospitals so they wouldn’t miss out on seeing their baby without physically being present. All of us made it a duty upon ourselves to involve families and update them on the care of their baby regularly, whenever we could, however we could.

However, it wasn’t the same. As healthcare professionals we worried deeply about long-term developmental issues separation would have on our babies and similarly parents were anxious about all these strangers surrounding their baby, their little loved one. The NICU journey is one itself that comes with a burdensome amount of anxiety and trauma associated with the specialised care preterm babies require, but on top of that, the pandemic meant our parents were sometimes behind closed doors whilst all of this occurred. This wall between worlds heightened their levels of stress and helplessness. For us, it brought to light the negative mental health impact this situation would have on ‘our parents’, we were immensely worried for them. For the longest time, there was no question about how vital parental closeness is for new-borns, yet now we faced upholding the opposite, even though we knew the health impact on our babies would be tremendous. We felt as if the choice was out of our hands.

However, as COVID-19 and the threat of lockdown after lockdown hit us time and time again, we started coming up with new ways to support our babies and families during this difficult time. We introduced delivery room cuddles where it became essential that we try to allow parents to cuddle their babies before they come to us on the NICU. We also put focus on the ATAIN project1,2 (Avoiding Term Admissions Into Neonatal units) to ensure we weren’t separating mothers and babies unless absolutely necessary. GLANCE3 (Global Alliance for Newborn Care) commenced a campaign to bring awareness to the disadvantages of separation and the importance of keeping sick and preterm babies close to their parents. We offered mental health guidance in the way of our family support team and psychologist. Despite the fears for our own safety and the safety of our babies and families, we felt more devastation in keeping parents away. Over the course of the last two years, we have learnt we need them present in order for our babies to truly thrive.

The reality of COVID-19 brought us many challenges but it taught us one lesson: there is no benefit to separating babies from their parents. Amongst all the medical and nursing care we provide, one truth is for certain: babies and families need to be together for better care.

Additional resources:

  1. NHS England, Reducing admission of full term babies to neonatal units available from: NHS England » Reducing admission of full term babies to neonatal units (19.11.2021)
  2. elearning for healthcare (e-lfh.org.uk) Avoiding Term Admissions Into Neonatal units (ATAIN) elearning programme available from: Avoiding Term Admissions Into Neonatal units – elearning for healthcare (e-lfh.org.uk) (19.11.2021)
  3. GLANCE; Global Alliance for Newborn, Zero separation campaign available from: Campaign – GLANCE (glance-network.org) (19.11.2021)

 

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