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A podcast from the Paediatric & Neonatal Clinical Psychology Service in the Northern Trust supporting the psychological and emotional experience of young people and their families, in living with health-related difficulties, or infants and families who need to spend time in Neonatal Care. The series will focus on providing information and sharing experiences that relate to families who are in contact with the Paediatric & Neonatal Services.
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Neonatal Part 1
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Hello and welcome to the Let's Talk podcast from the Paediatric and Neonatal Clinical Psychology Service in the Northern Health and Social Care Trust. This series will consider and discuss a range of topics relating to the experiences of children and young people living with health related difficulties and their families.
We also provide a service to infants and their families who need to spend time in neonatal care. My name is Aiveen Higgins, and I'm the clinical psychologist working in the neonatal unit in Antrim Area Hospital. And I'm Lauren McKay, a training clinical psychologist on a specialist neonatal patient. In today's episode, we'll be talking about the psychological challenges of the neonatal unit for the babies and their families.
We'll also talk about how psychology fits into the neonatal team, supporting the psychological well being of infants, parents and families. So, I've been on placement for a while now, so I know what the psychology service looks like. But if I was a parent who had never heard of the service before... How would you describe it to me so I got a sense of what the service was like?
Well, my role on the team is to help parents look after their emotional wellbeing and the emotional wellbeing of their infants and the whole family. There's a lot of challenges having a baby on the neonatal unit. It's a rollercoaster journey, and sometimes parents can find it helpful to talk to somebody, like a psychologist about it.
Maybe what they've been through, like a difficult birth or maybe what's happening for them right now, like the challenges of feeding a baby in the neonatal unit or worries about siblings at home, or sometimes they want to talk about maybe concerns they have for the future, especially coming close to discharge.
Sometimes it's moms who like to spend time talking with me. Sometimes it's dads. Sometimes parents like to meet with me together as a couple. To think about what they've been through and what they're going through. Sometimes they want to meet with me to talk about brothers and sisters at home. Sometimes parents like to meet with me just once or twice, or other times they might like support right throughout their neonatal journey, maybe once or twice a week.
Other parents say that they have support from their own family and friends and they like to know that we're there in the background and may use me at some time. There's some parents meeting with a psychologist feels too much at the start of their journey and they've enough to get their heads around and they like to maybe delay meeting with me until closer to discharge.
So it's whatever the parents want that we provide. It's a really helpful overview of what the service looks like and what parents can expect from the service. I'm just wondering how they would go about accessing the service if they're on the ward and they do want to speak to the psychologist. Well, we try to make it as accessible as possible.
So we make sure there's psychology leaflets describing the service available to parents, and often staff will pass these to families at the start of their neonatal journey. We have a poster with our pictures on it in the family room where family members can go and have their tea and coffee and a bit of time out.
So they'll see, they'll see a bit about the service on the poster. Sometimes staff members might suggest to a family that psychology might be useful and ask if it's okay for us to pop along and introduce ourselves. And that can be for families where maybe they've had a particularly difficult time.
Maybe they've had a previous loss or a very difficult birth. But most of the time you'll probably just see myself and a trainee like yourself Lauren about the ward, at the ward rounds, talking to staff, meeting with families. And often we'll just informally introduce ourselves to babies and to families, especially all our new babies who like to go around me.
them, say hello to them, and introduce ourselves to parents. So if they have a face to a name and it makes us seem a bit more accessible, hopefully, and then parents can decide themselves when it is that they want psychology or if they want psychology. And before I started placement Aiveen, I was curious about where families would be seen.
And I think my own assumption was based on psychology services I'd worked in before, where you might see families in a private, quiet clinic room. It's quite different on the neonatal unit. And actually a lot of parents really value the precious time they have when they're with babies. So we tend to see a lot of families on, on the unit and at the cot side, which is a lovely way to engage with psychology.
And that's it exactly, Lauren. There's a lot of flexibility about where we see our families. And unsurprisingly, most families want to stay beside their baby, especially for parents who, for whatever reason, can't be there as much as they'd like to be. Maybe because it's a dad who has to return to work because he's saving his paternity leave for when baby comes home.
Or maybe it's for a mom who can't get up because she can't drive after a C section. So, for most families, especially those families, It's really important for them to spend as much time as they can with their baby. And it can be really lovely meeting with parents and having baby there as part of our session.
That way we can observe baby together and look at the lovely interactions between babies and parents and learn about baby and how baby's communicating. And also, I think it's helpful for parents to have it pointed out how well they're doing in terms of understanding their baby's cues and how they're getting to know their little baby, even though they're so, so tiny.
For parents who do want a bit of privacy, we do have our family room, so sometimes parents will opt for maybe some other sessions to be there where they can have a bit of space. And I guess we can be quite flexible with that as well too, because for some parents, actually a bit of time away from the ward and a bit of a respite from that environment can be really helpful for them.
So we do have the option of meeting in the family room. They're close by the ward if they feel like they need to get there quickly, but they're also maybe far enough away to give themselves a bit of head space and, and to bring them away from that environment. So we can be really flexible and meet the parents where they're at and just be led by them with how they want the appointments to look and where they want those appointments to be.
And as we all know, baby is boss. So while we always accommodate parents needs, everybody accommodates baby's needs, sometimes babies will decide, actually, sorry, mommy and daddy, I need you right now. So you're going to have to delay your psychology appointment. And a different way of Arrange to meet at 10, but we end up meeting at half 10 because baby needs to have a feed or needs a nappy change or needs her bath and that's absolutely fine too.
And the other thing to mention is that there's no wait for babies and families to be seen in the neonatal unit. We talk a lot about waiting lists for psychology in the community and actually babies shouldn't have waiting list. So families can access psychology very, very quickly once they decide it's something that they might find helpful.
I'm really mindful even that. There can be a lot of other responsibilities that parents are trying to juggle throughout their neonatal journey. So like you mentioned, dads might have to go back to work and donate, taking their maternity leave until closer to discharge and baby coming home. Or sometimes moms can't drive yet because of their C section or there might be other siblings at home that they need to look after and care for.
So I'm curious, are there any other ways that parents can access? Psychology support, if there are those other obstacles or barriers that make it really difficult for them to access psychology on the internet. Absolutely. We have psychology information available to families that they can look over at their own time.
We have leaflets, we have our podcasts, we've information that's available on things like that. Absolutely. How to bond and connect with your baby on the neonatal unit, or how to try to find ways of managing your anxiety and stressful situations. We have our sibling packs with advice on how to look after the needs of brothers and sisters at home.
And we're always very mindful of parents who cannot be on the ward. as much as they want. And I guess that came from our time during COVID when a lot of our parents had to isolate and miss lots of time with their babies. So that was when we developed a lot of these resources, which we still use today.
Some parents may not need or want to meet with a psychologist. And actually their preference is just simply to listen to a podcast or read a leaflet and they get the information they need from that. And they don't ever need to meet with us. And that's absolutely fine too. And I've noticed from being on the ward and working on the ward.
That supporting the neonatal staff is a key part of psychology's role as well. Tell me a little bit about that. Yeah, I think as staff in the neonatal unit, whether you're medical or nursing or allied health professional or psychologist, you're really mindful that a lot of our role is looking after the whole family.
And if we can look after the parents and family members, then that enables them to look after a baby. To do that, we have to look after ourselves. So, as staff, we're very good at keeping an eye on each other. And as a psychologist, I'm very aware of the importance of staff feeling that they have support as they need it.
So, we look after ourselves with our mindful Mondays where we pause and do some relaxations and mindfulness for 10 minutes during the day and we have cups of tea with each other and check in on each other and I think it's really important for parents to know that because parents will sometimes say to me, I don't know how those girls do that job or I don't know how the doctors and nurses get up in the morning and look after all these babies and I'm always really amazed that parents in the midst of their own challenges and their own experiences are able to think of themselves.
How it is for staff members. So it's important for them to know that it's okay. Staff are looking after themselves and each other. And we will be able to look after you. And it's okay to talk to us about big emotions or difficult experiences that we are there for you. I was really curious before I started this placement about what to me.
I haven't had a placement or worked in a ward environment before, so I was, I guess, holding in mind what some of the challenges might be associated with the ward environment. Yes, and I think it's really important to talk about the challenges of being in the neonatal unit as a baby or as a family member.
It can be a really lonely place in the neonatal unit because you can feel quite alone with your feelings. So it's really important to have that normalized, but you know, it's a challenging place to be. It's difficult. Families call it a rollercoaster journey for them. And I guess I'm just wondering what you first noticed when you arrived in the ward, because it can be really helpful to hear a tradie's perspective coming brand new.
Yeah, I think before I even set foot on the ward, I was probably quite anxious about it. I didn't. I didn't know what to expect and I'd probably built up an assumption or an expectation in my mind of what it would look like and I guess then stepping onto the ward for the first time was, was overwhelming for lots of different reasons, whether it was from getting used to washing your hands every time you're on the ward and your hands on the tither and all that, you know, the procedures you have to do to make sure you feel safe and don't bring infections in or whether it was.
the different rooms that there are and getting used to where they are and who is in those rooms. All of the machinery and the sheer amount of staff as well. There's so many staff. Every day you seem to meet a new person there. So it was very overwhelming when you first go on there. I would say for the first couple of times, anyway, from my experience.
But within that, I guess, overwhelming Feeling, there was always a sense of trauma as well, which was something I didn't expect to feel on the ward. There was no sense of chaos or anything being out of control, so even though I knew I was getting used to all of the new things, it still felt... very calm and continuing as well.
That's really helpful to hear because I've been on the unit for many years now. So I suspect there's lots of things that I don't even notice anymore. So the beeping of machines and the bright lights and how clinical it looks. So it's really helpful to hear your first impressions because they will probably be similar experiences for our parents and family members who come on to the ward.
You've talked a little bit about the physical environment of the ward. I'm wondering what your first first impression was when you came in on that first morning and got to meet all the little babies. I think that was interesting as well, because I've not met many babies before that are premature. So the first thing that struck me was how small they are, how tiny the babies are.
And then with that, I felt very much like they're vulnerable and fragile and there certainly is an urge or a want to really protect them and make sure they are safe and keep them safe. It's hard not to notice. All of the machinery that is around them. So when that is their feeding tubes, you know the wires from the oxygen machines that they're in an incubator.
So even before you get to notice the be a, sometimes you're just focused on everything that is around them, and it feels like quite a physical barrier between you and baby. So even though. they're vulnerable and you have this urge to protect them. You're also constantly reminded that you have to be so careful with them as well.
I think it's probably one of the biggest challenges for families in the neonatal unit, that barrier or that separation from their brand new baby. And there's a very physical barrier with the incubator and often baby's eyes are covered at first so you don't get to see their eyes or they don't get to see you.
Our instinct as Parents is just to lift up our baby and hold them close, but you can't do that when your, your baby is connected to wires and tubes and you have to ask for help from staff to lift your baby out to have your kangaroo care or skin on skin care with them. So I think it's really, really difficult.
And a lot of parents talk about the experience of feeling not quite like a parent or feeling like their baby belongs to the unit and not them, which must be so, so difficult. And especially for first time parents where, you know, you're. You're transitioning from being a couple into being a family of three or four if you've twins.
And to have that sense of it not feeling quite real or you're a parent on the unit and then you go home and you're not a parent because you don't have your baby at home. So I think that's really, really difficult for families. There's lots of other ways, of course, of feeling separated from your, from your baby and the first separation when your baby is born and they're taken off to neonatal is really, really difficult.
First separation from baby with a full term baby is difficult. And that's when your baby is maybe a few months old and you're separating to go for a nice meal out or go to the cinema and you're checking on your phone and you're getting lots of nice messages from a trusted relative or friend. So you can imagine how difficult it is for parents when that separation is straight after birth and you're worried about your baby.
You don't know what's happening and they've been taken off to an intensive care unit. It's really, really scary. Another separation that families really find difficult is separation. When mom has to go home from hospital, so when mom is discharged from the maternity unit and has to leave her baby behind, before she would've been separated by maybe just a corridor, and now she's separated by train journey or car journey, and that's a really, really hard stage.
You've talked a lot there by. Separations from mum's perspective, naturally so, but I guess I'm curious about what separations might be there for dads and partners and also siblings as well. Yes, everyone feels the separations within the family. So for dads, it can be really hard going home on the first night, leaving mum behind and leaving baby behind.
It can feel a little bit strange because you've just become a parent. And then you go home and if you have no other children at home, you're going home to an empty house, maybe just the dog there. And it's almost like being single again. So it can feel really surreal. I have a baby, I am a daddy, but I'm here alone in the house.
So that's really difficult. And then of course, siblings at home, being separated from mum and dad and having a new baby brother or sister, but not having met them yet can feel really, really difficult. And for me, even so far. One of the main things that sticks out the most when you're on the unit or when there are new families coming into the unit is the loss that is, is surrounding the families and their journey so far.
What would you have noticed in your experiences? Yes, most families will experience losses in the neonatal unit, so it might be the loss of the third trimester. You might have had really lovely plans for winding down for your maternity leave, or maybe having a bit of a baby shower, or nesting, preparing your home, and then suddenly that's disappeared.
Sometimes, mums talk about looking for their bump and it's gone because they haven't had that third trimester in which they got really big and uncomfortable and ready to not be pregnant anymore. The pregnancy has been cut short too early. There can be a lot of loss around the imagined birth that you planned as a mum or as a dad and partner, and then loss of maybe the ability to breastfeed or even just loss of taking your baby home and showing him or her off to their family and friends.
Sometimes families are revisiting previous losses, so some of our families very sadly have had previous miscarriages or stillbirths or IVF attempts that haven't worked out for them, so they're carrying that loss all the while meeting their new baby. And that can feel difficult to grieve for previous losses at the same time as feeling so happy that you have your, your brand new baby.
And sometimes the loss is a future loss, so it's perhaps the loss of a future you'd imagined for your baby. So, perhaps a baby born with a disability who may not have the future that you planned for him or her. And I suppose the important thing for parents to know is that it's, it's really normal to grieve your loss and really important to be able to allow yourself to feel sad about those losses.
Hearing you talk about that Aiveen, it sounds like there can be so much loss for parents. You touched upon parent losses, previous losses, or future losses for parents. And I guess within all of that it sounds like parents can be exposed to lots of really difficult experiences before they even set foot on the neonatal unit.
I think before our parents even get to the ward, they can already have been through a really difficult time and can have quite a lot of big emotions in response to this. Sometimes it's previous pregnancies or births that have been really difficult, or they may have had a previous neonatal experience.
Sometimes those challenges are very current, so they might have recently been through a high risk pregnancy or a really difficult birth. And sometimes it's the experiences on the neonatal unit that are really, really challenging. So they may have witnessed something really difficult for their infant or other infants around them.
And it can take a really long time to make sense of all those experiences, especially when they build up. And it doesn't always happen immediately. It can sometimes take a while for families to make sense of what they've been through. So some of the things that parents may experience are anxiety or fear, loneliness or powerlessness or helplessness.
Sometimes parents talk a lot about guilt or shame. Mothers can mention, my body didn't keep her for the third trimester and feel really, really angry with themselves or feel really guilty, even though their heads tell them there's nothing they did or didn't do to cause this. Their hearts still say it's my fault.
Dads can feel really guilty that they weren't able to protect their baby or their mother. Even though, again, their heads tell them there was nothing he did or didn't do. And it's important for parents to know that there's no right or wrong way to feel about being in the neonatal unit and that sometimes you're going to feel many emotions all at once.
And I guess something else to bear in mind as well is, is not just the emotional impact but also the physical impact for parents whenever they're all award. So for mums and dads and partners. There might be a lot of sleepless nights around, so for men, maybe that is just the exhaustion after labor and the birth experience.
They might also be pumping and expressing milk they happen to get up during the night to try and get that supply through for baby. Monks might also be a lot of peeing, so they have a C section, so there's lots of physical impacts that might be going on for the families on top of the really big emotions that you've talked about.
One thing I've noticed as well since fetal placement is some parents will often express worries or concerns about how to connect with their newborn baby, especially given all of the physical barriers that we've talked about, like the incubators and all those, the tubes and the, the wires that are attached to the baby.
So I was curious about your perspective on that in terms of how parents can connect with baby or the challenges they might experience if that went their own ward. Yes. A lot of parents say it feels really different from how they imagined it. They imagined giving birth, seeing their baby falling in love and then just having all this time and not being separated from their baby.
And of course, it's very different on the neonatal unit with lots of obstacles. So those physical barriers you talked about with the equipment and then the separation that we've already spoken about. And it can be scary as well, I think, to fall in love with your baby and connect, especially if you've had.
a previous loss. And then if you add in lots of really big emotions, physical exhaustion, experiencing pain into the mix, and that can make it difficult to feel connected to your baby. And we're very mindful on the unit of trying to support families as much as possible to connect with their baby and try to work around these obstacles that we put in their way.
So we encourage skin to skin. as early as possible, both for mum and dad. Dads can sometimes feel that they should give all the skin to skin time to mums, but actually they're really important too to baby. It's important for baby to have time with dads or with partners. We're also aware that it's really important to look after our parents physical wellbeing.
So we try to look after them by making sure that they have vouchers for the canteen, that they feel well rested, that they get to stretch out on those more comfortable armchairs while they're nursing their baby. And we also have some leaflets on how to connect and bond with your baby, which can have some useful advice for parents.
And sometimes psychology can help with that. And it can be as simple as just meeting with the psychologist as parents and baby and spending time just getting to know your baby, recognizing cues and having somebody outside of your family like a psychologist point out how well you're doing in terms of attunement and reading your baby's cues and responding.
And I suppose one of the most important things for parents to remember is that bonding is a bit like falling in love. So it's not just about falling in love in a very sudden flash. It happens to some of us, but the vast majority of us fall in love more gradually as we get to know a person. And it's the same with our babies.
So instead of bonding happening in a moment straight after the birth, it's just a really gradual process as you get to know your baby and they get to know you. So it's always helpful for parents to be reassured that it's not just a moment that you've missed because you were separated from your baby after birth and that it can happen in a really slow and gradual way.
In this episode, we have discussed some of the ways of supporting yourself and your family on your neonatal journey. Further information on our service can be found on the website where you access the podcast. In the podcast summary, you'll find a short survey link, which we would really appreciate you taking a few minutes to complete.
Your feedback on the podcast you have been listening to today will help us to shape future podcasts. Thank you Lauren. Thank you Aiveen. And thanks to everyone for listening.