Being a parent on the neonatal unit

If your baby was born prematurely or sick, they were probably taken away from you soon after birth.

Arriving in the neonatal unit can make many parents feel like they aren’t doing what parents should do for their baby. Parents often feel helpless and worried. This is completely normal.

You may have imagined your first moments with your new baby being full of joy - being in a neonatal unit often takes those moments away from you.

Health professionals understand that it is really important to support families to parent their baby when they are on the unit.

They also know that it is really important that you always know what is happening with your baby, and that you have the information you need. This type of care for you and your family is called 'family-centred care' and 'family-integrated care'.

What is family centered care and family-integrated care?

Family-centred care helps parents and families connect with their baby. It also helps your baby to bond with you, be comforted, and get used to things like kangaroo (skin-to-skin) care and breastfeeding.

Parents being involved with their baby’s care is shown to help their baby’s progress and development.

Some units now use a model of care, called ‘family integrated’ care – often called ‘FICare’ by staff. This is a model of neonatal care designed to make families the primary care givers for their baby, in partnership with their care team.

On a FiCare unit, the care of the baby is often planned around the needs and availability of the family. There is more information on FiCare further down in this section.

We’ve included some things below you might like to try to get more involved in your baby’s care. Talk to a nurse or member of the team about what else you can do to parent your baby on the unit.

See our page about getting involved in your baby's care for more information.

For some parents, the care needs of their baby may mean that there are limitations on how much they can physically care for them. Not being able to hold them whenever you want, or take them home to show your family and friends, can make you feel like you are distant from your baby.

There are some things you can try to help with this feeling of separation.

Talk to a member of the neonatal staff about how they can support you to try some of these:

• If your baby is in an incubator and isn’t ready to be picked up, ask your care team about ‘comfort holding’. This involves placing one of your hands on your baby’s head and the other at the base of their feet.

• Putting a small square of material that smells of you in your baby’s incubator. They will recognise your smell and it can help to calm them. This can also help you to feel you are there, even when you aren’t physically there. It’s recommended that you have two pieces of cloth or clothing to put in your baby’s incubator. Keep one in the incubator and one on yourself.

• Having something which smells of your baby close to you. This can help them feel nearer to you. If you are expressing milk for them, the smell of your baby can also help your milk to flow.

• Marking important milestones with your baby – gaining weight or coming off a piece of equipment are big steps for babies in the unit, and celebrating these can help you feel like you are making progress, together.

You can celebrate each milestone in your baby's journey with Bliss Baby Cards, specially designed for babies in neonatal care. You can order Bliss Baby Cards via our online shop.

Watching your baby

It is really important to spend time getting to know your baby. Sometimes you might feel like you spend a lot of time just looking at them.

Watching your baby can help you to learn how they show signs they might be uncomfortable or in pain, as well as being calm and content. This can help you to know what you can do to soothe and comfort them.

Combined with your natural intuition as a parent, watching your baby will help you to help the doctors and nurses. Together you can tell when your baby might not be feeling very well, or might be in pain. The unit should have a place for you to write some of this information in your baby’s notes.

Skin-to-skin

Sometimes called ‘kangaroo care’, this means placing your baby undressed onto your bare skin on your chest, so that your skin touches. This is shown to help you to connect with your baby, as well as calming your baby if they are feeling pain or stress.

It also has been proven to help your baby’s sleep, growth and has other physical benefits. Mums, dads, brothers, sisters and other family members can do skin-to-skin.

Staff will let you know if your baby is ready to have skin-to-skin with you – sometimes you might need to wait until they are more stable.

The team will help you to get your baby onto your chest. This might take a little time if your baby is attached to wires or a ventilator. They will show you how to support your baby and make the most of this time together.

For kangaroo care to really benefit your baby, it’s helpful if you can do this for at least one hour if possible. Make sure you are really comfortable, and have everything you need before you start.

For more information about skin-to-skin care, visit our page - Skin to skin and kangaroo care.

Babies on the neonatal unit can have breastmilk, donor breastmilk, or formula milk. Your baby may not be able to have suck feeds straight away but can be fed milk through a tube straight into their tummy. This is called ‘enteral nutrition’.

Sometimes a baby’s tummy might not be mature enough to digest any kind of milk, and so they are given their nutrition through their veins. This is called ‘parenteral nutrition’, or ‘PN’.

Parenteral nutrition is a special liquid which has the right balance of nutrients to help the growth of babies who aren’t able to have milk yet. This is likely to be the case for babies born very early. This type of feed can also be given through a vein in their umbilical cord.

Sometimes a fortifier is given to some babies to make sure they receive all the nutrients they need on top of their breastmilk. This is added straight into their milk.

Moving on from tube feeding to suck feeding (or breastfeeding) is a milestone which most babies will take time to master before leaving the neonatal unit.

Your baby will start to show signs they are ready to try suck feeding by their own patterns of hunger, wakefulness, feeding cues and communication.

You may notice these during skin-to-skin or at tube feed times. Offering your baby opportunities to suck in response to these cues allows them to develop their suck feeding skills at their pace and following their developmental skills. Your care team will be available to help you with this transition.

Breastmilk and breastfeeding have specific benefits for preterm babies. It can take time for your baby to learn to breastfeed. With support though, they will be able to receive the nutrition they need from breastfeeding.

Your neonatal team will help you and your baby to practise their suck feeding and to need less tube feeding so they are ready to go home.

Feeding is a great time to be involved with your baby’s care and make lasting memories you can treasure as they move from skin-to-skin to sucking and feeding without a tube.

Lots of mums have difficulties with breastfeeding and expressing - this is completely normal. The NHS website has lots of information and links to breastfeeding support groups who can help - NHS Start4Life breastfeeding advice

Washing and changing your baby

The nurses and neonatal team can support you to wash your baby and change their nappy. This can feel difficult when they are connected to wires and monitors.

The nurses will show you the best way to do this to make sure your baby is comfortable when you feel ready.

Doing these things, sometimes called ‘your baby’s cares’, helps parents to be more involved in their baby’s day-to-day needs. This can help you to bond with your baby.

If your baby was born prematurely, regular nappies might be too big. Ask your unit if they have some Pampers Preemie Protection nappies – they have three sizes, specially made for the smallest babies.

These are available for units to order for free. Visit our page on Pampers for more information.

Making decisions and getting consent for your baby’s care

Your baby is at the heart of your family. The neonatal team must include you when talking about your baby and support you when decisions need to be made.

Your unit should encourage you to be there and talk with the doctors during their rounds. You may not always be able to see a physical copy of your baby’s medical notes because they are stored digitally.

You may need to make a formal request to see your baby’s full medical record but your care team can help you do this. They will be happy to talk to you about anything that is unclear.

The care team need to get written consent from you for operations and some other procedures. This means getting your agreement that the operation or procedure can happen to your baby.

If you are not on the unit, for example in the middle of the night, and your baby is unwell, urgent decisions might be made quickly to make sure your baby gets the best care.

This may also happen if there is an unexpected change in your baby’s condition. The team should talk to you about these decisions as soon as possible.

This model of neonatal care is an extension of family centred care that some units are now practising. The aim of family integrated care – often called 'FI-Care' – is for parents to become the primary care giver for their baby while on the unit.

The unit care team will provide a structured programme that helps parents to be as involved as possible in their baby’s care. It also supports parents to make the most of their time on the unit. If you are on a ‘FICare unit’, it is important to remember that you do not have to do all the FICare activities if you do not feel comfortable.

The staff will guide you every step of the way and these responsibilities will become easier to deliver over time.

FICare activities may include:

• Supporting the preparation of care plans on a daily basis, whether you are on the unit or not

• Contributing to your baby’s ward rounds e.g. introducing your baby and updating staff on how your baby is progressing9

• Carrying out basic day-to-day cares e.g. washing and changing, as well as more advanced cares, such as attaching monitoring equipment

If you would like some more information about FI-Care, your care team will gladly talk to you about it.

Having a sick or premature baby in a neonatal unit can have a huge impact on you. The experiences you might face on the neonatal unit, and while you are away, can affect your emotional wellbeing and mental health.

It is very common for parents to forget about taking care of themselves while they are on a neonatal unit and if they are unable to be with their baby on the unit. Your thoughts are likely to be almost completely about the care of your baby.

It can be difficult to think about yourself and your own needs. But remembering that you are a person that also needs care is very important to your own and your baby’s wellbeing.

Some tips from parents that helped them through their time on the neonatal unit:

• Writing a diary of how you are feeling day-to-day.

• Writing down questions that you would like to ask your care team. There are some common questions you might like to ask your care team further on in this section.

• If you are staying on the unit, it can help to spend some time outside each day – this could involve going for a walk or just finding somewhere outside to sit down and get some fresh air.

• Spending some time at home while your care team looks after your baby – going home for a good night’s sleep or a good meal can really help to improve your wellbeing. This can feel really difficult but your baby will be well looked after while you are away.

• Asking your care team how you can be most involved in your baby’s care. If you are only able to be on the unit for a certain time, ask your care team if they can make a care plan with you so you can get the most out of your time with your baby.