Subscribe
Share
Share
Embed
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.
Please give your feedback here https://forms.office.com/e/6M0RhzHtjR
Neonatal Part 2
===
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 trainee clinical psychologist on a specialist neonatal placement. In today's episode, we'll be talking about how psychology fits into the neonatal team, supporting the psychological wellbeing of infants, parents and families, and how to look after yourself on your neonatal journey.
So far thinking about How difficult the neonatal ward can be, primarily for mums and dads and partners, before they get on to the unit, the time that they spend on the unit, and then when they're getting ready to go home with baby. I'm mindful that we may be. Not talked about other members of the family, so I'm thinking about siblings who might be at home and grandparents as well, who might not be able to come to the ward to visit.
And I'm curious about what challenges you might have heard about from the sibling perspective or from a grandparent perspective. We're always very mindful of siblings at home who may not have had the chance to meet their baby brother or sister yet, so they can have lots of very confused feelings. They may wonder why baby's not at home and why haven't they met them yet.
It can feel almost unreal. That they don't really have a brother or sister and they can have a lot of big emotions too. So they may feel quite gross that mum and dad are spending all their time up at the hospital and not with them. They can feel left out. They can feel jealous and they can feel really sad and lonely for their parents, but also lonely for this new brother or sister that they haven't met yet.
They can sometimes feel like their needs aren't as important as the baby's, so why aren't you coming to my sports day, and why aren't you picking me up from school, who's going to mind me today, so they can have a lot of difficult feelings from a very young age. And I guess one of the important things for parents to know is that it's okay to give them permission to feel all those feelings.
Just because they feel jealous or cross doesn't mean that they don't love their new baby brother or sister or that they won't love their new baby brother or sister. And we're also very aware of grandparents as well who will be worried about their own baby. Who of course is a grown up adult who's now a parent themselves.
So they'll have worries for their child and then they're worried about their child's child as well. And they can carry a lot of guilt. They'll often say things like, it should be me in hospital and not my grandchild. I'm really interested in what you wrote. Say in there in terms of siblings and I guess the range of really big emotions that they might be experiencing or the questions that they might have about where their baby brother or sister is and Thinking about it from the perspective of the parent, maybe.
What can they do in those situations to help siblings with those big emotions? Or to explain to them a little bit about why their baby brother or sister isn't home yet? Any tips? I think in terms of the big emotions, I think first of all, just naming them, often children and especially small children aren't able to identify what the emotion is.
So they need help from an adult to say, I wonder if you're feeling cross with me because I'm not there for you or I missed your sports day. Or I wonder if you're feeling a bit jealous of a new baby brother and then also giving permission and saying, and that's okay. I also feel sad, and I miss you at night, and would like to be there to read you your bedtime story, and I'm really sorry that I haven't been there for the last few nights.
So naming it and then normalizing it, I think it's really, really helpful, especially for younger children. Sometimes children like to have something physical to help them, remind them that they're important to parents. So sometimes I'd suggest You know, maybe little worry stones or little teeny tiny worry dolls that parents can take one and brother or sister at home can take the other.
And you can say anytime you feel lonely for me or if you have any big emotions, you take that out and hold it tight and squeeze your eyes shut and you remember that I love you so much. And that can be enough, something physical that helps them get through a difficult moment. Another thing that can help is to help brothers and sisters connect with their baby, and that's really hard because they may not have even met baby brother or sister yet, and just like mum and dad, they need to fall in love with the new family member.
So sometimes you can help those connections by suggesting maybe they do a nice drawing that can be brought into the hospital and put in the incubator, or they might like to pick a soft toy to bring to baby, or sometimes babies are very generous and they send home a soft toy to their big brother or sister.
Sometimes it helps to feel included if they get to pick baby's first outfit or a brother or sister is old enough to read, they might like to read their favourite story, have it recorded and sent in. Or they might like to sing a song or tell a little story themselves or even just tell baby about their day.
And we use iPads a lot on virtual platforms so that brothers and sisters can connect with their baby even if it is in a very virtual way. We also provide brothers and sisters with certificates to congratulate them on becoming a big brother or sister. And we have sibling packs, which we give to parents, and that gives lots of tips and advice on how to support brothers and sisters.
And we have a little booklet for brothers and sisters, just explaining about the unit and trying to make some of the equipment seem less scary. And also to remind them that we know that they're there, we know they're important family members, and we are thinking of them. And as we're thinking about... The family more generally, it's really hard not to think about mum and dad or partner as a couple and as that unit that are usually together most of the time and spend a lot of their time together and how that must be really suddenly disrupted for them.
And you often would. hear them talk about how there are ships in the night and they're just passing each other and the quality time they used to have together maybe isn't there anymore because they are obviously prioritizing being at the unit and spending time with baby. Something I've noticed, and you can keep me right with this, is maybe they're both quite protective of each other.
So, dads and partners might not want to share how difficult they're finding things or their experiences of the birth and the neonatal unit with mum because they're trying to protect her and look after her and look after baby. And similarly then, mum might be trying not to share a lot of things with dad, mindful that they're back to work and maybe they're caring for siblings at home.
I guess it's just, it's really complex for couples whenever they're on the neonatal unit. So I'm curious about whether that would be a thing that would come up for you when working with either mums or dads and partners separately or when working with couples together. I think a lot of parents of full term babies experience a massive transition.
This huge event happens. If they're first time parents, they go from two to three and it's a huge adjustment. Then if you throw in a neonatal experience where they may have been exposed to just a really difficult birth, both mum and dad thrown into the neonatal world, having to learn lots of new language, medical jargon, and all the concerns for their baby that goes with it it's really, really difficult for couples, as you said, they often feel like ships in the night and they're trying to spread themselves perhaps between brothers and sisters at home and maybe a partner going back to work.
So the normal time that you have to connect with each other and talk about what you've been through just isn't there. And sometimes that has to happen a little bit later. I, I think one of the things that can help couples is to realize that you've both been on this journey and continue to be on this journey, but you've slightly different perspectives.
And as you said, sometimes feeling protective of your partner and not wanting to let them know how. distressed you are can be part of that. I think our dads in particular will often dampen down those emotions and just pretend they're doing okay, but actually letting their partner know they're upset visiting the unit, that they feel really tearful when they're leaving I think can be really helpful.
So actually in trying to protect, we sometimes make things trickier because the other person thinks, maybe he doesn't care. He doesn't seem to mind leaving the internet at all. He comes on for 10 minutes and then disappears for a cup of tea. Mums are just so angry, but behind it they're so hurt. And then you find out when you have the couple together, you find out dad went off the ward during his own dad to talk to him in floods of tears.
He just didn't want mum to see it. So it can be really helpful for a partner to say, actually, I have to leave after 10 minutes because I'm trying not to cry. I don't want you to see me. Instead of maybe staying on the unit and just having a little cry with mum, and that's okay too. So, I think just checking in with each other and recognizing you'll cope in different ways, because often we're attracted to people who are different from us, who complement us, as opposed to being attracted to someone exactly the same way.
So, chances are you'll have different coping strategies from your partner, and also you'll have experienced different parts of the journey in different ways. So, you will have different perspectives, things that you found very, very hard that your partner maybe Managed a little differently. One of the things I've noticed as well is how important it can be to try and keep a sense of normality.
For the parents, so whether that might be when they do go home from the war at the end of the night that they go home and they do something they would usually do and they fall back into their usual routine, so whether that's sitting on the sofa with a cup of tea, watching their favourite show, or going for a walk with the dog, and just trying to make sure that they're still connecting with those activities that soothe them.
And give them comfort, especially at a time when things are so difficult and uncertain and unpredictable for them. And it can be a nice way for them to keep. The connection between themselves together at a time when they probably can't feel so disconnected from each other. We've spent a lot of time so far, haven't we, thinking about parents, grandparents, siblings, the staff on the ward as well.
But within all of that, we can't lose sight of the newest member of the family, which is the baby. So something I've maybe observed or picked up on when I'm On the board is, I guess, the sheer amount of people that are passing through and all the different faces for babies day by day. All the new people they're meeting, all of the new voices they're hearing.
And I guess it's important to bear in mind or think about then some of the challenges that might be around for baby during their time on the, on the unit. Yes. The baby is at the core of the neonatal unit and we're so mindful of baby's experiences and the challenges for them. And they experience very similar challenges to parents and siblings and grandparents.
We always remember that they are teeny tiny little people with their own personalities. We like to. Introduce ourselves to them. We talk to the babies. We let them know if something hard is going to happen. And we try to help parents to comfort them as much as possible. And we're very aware that the neonatal unit isn't an easy place for babies to be.
So they experience separation too. I wonder why has my mummy and daddy gone away? Why is there plastic between me and the people caring for me? Why can't I see you? And they're all really difficult experiences for a brand new baby. There's all the physical barriers we talked about earlier. So babies might be wondering, where's my cuddles?
I'm a brand new baby. I'm supposed to be held loads and loads and for some reason I can't be held right now. Or, as you say, they might wonder, why are there so many people, so many voices and so many different accents here in this place? Oh, there's mommy's voice. There's daddy's voice. My goodness. I recognize them.
And they can experience the neonatal unit as uncomfortable. So it might feel very bright or a bit noisy, especially our very premature babies who are supposed to be inside the womb for a lot longer and not supposed to be exposed to. Very loud noises, usually they're cocooned from light. We do our best in the unit to reduce all that stimulation, but it can still feel really uncomfortable.
I always remind parents in the ward that while there might be multiple carers who are there to provide nursing expertise or medical expertise, mum and dad are constant, and babies will recognize mum and dad's voice from when they were in the womb, they'll be familiar. They'll be comforted. They recognize mum and dad's smell.
And then when they get skin on skin, they'll recognize the feel of their mummy and the feel of their daddy. And all that is so important and so irreplaceable. So while there might be multiple carers, there's only one mum and dad or one mum and partner. I think picking up on what you said there, I think one of the most special parts of working on the unit From a psychologist perspective, from my perspective mainly, is witnessing that lovely connection between baby and mummy and daddy and parents.
And it's so special when you see baby open their eyes when they hear mummy or daddy's voice or when they give you a little smile when they hear them talking. And it's just such a special moment to be able to see that between. The little family unit on the ward, and it's just, it's hard to describe how lovely a moment it can be.
And if parents aren't able to recognize that, like you said, we can be there to observe that and reflect. Yeah, no, I agree. I think it's, it's probably one of the nicest parts of working in the unit and you just see the, see these beautiful moments and you see the look of love on a baby's face for their parent and the look of love coming back from, from their mummy or their daddy.
And I often see. Can I take a photo? Sometimes parents say no, we've got like a million photos. Thanks. But most times they'll say, oh yes, please. Because often their photos are of their baby. And I mean, you just wanna have photos capturing baby and parent or baby, and both parents and they have their little family unit and you can see in the photo that look of love.
It's just so beautiful. We've talked quite a lot so far, haven't we? About barriers, physical barriers on the ward. That might make it a bit more difficult for parents to feel like they can connect with baby. And we've touched upon the fact that bonding isn't one moment in time, and if you miss it, then it's gone.
But it's a much more gradual process that is nurtured and developed throughout child's whole life, really. So it just grows over time. But if parents were maybe worried about the difficulties with bonding with baby on the unit, Or what that might look like whenever they go home. I'm wondering if there are any activities or strategies that they could use that would help to nurture that bond.
I think you've made a number of really good points there. There's ideas around how to try have more moments with your baby and nurture the bond. And then something about going home. In terms of. Building those connections on the ward, things that can help are just being with your baby, like really being with your baby and looking at your baby.
There is nothing a baby loves more than to be looked at, because they feel visible, they feel important when you look at them. And you probably do find yourself looking at the babies. I know as a staff member, I spend a lot of time just looking at baby. It's a, it's an almost primitive instinct. So just spending time just looking at your baby, watching and observing and, and talking to your baby.
Because your voice is the most beautiful sound in the world to your baby and they're familiar with it. So you can talk about anything. You can tell them about the recent developments in the Netflix show you've been watching. I have heard dads telling them the football results. It doesn't matter. Babies just love the sound of the voice of their loved ones.
You can sing and we do encourage our parents to sing in the ward. I have heard staff singing to babies on a regular basis and I think it's nice because parents then go, Oh. I'm allowed to do that. And there is no judgment at all. Again, you could have the most terrible voice in the world and your baby will think you are the most beautiful singer ever.
So just singing maybe nursery rhymes that you know from your childhood or that you might have sung to your older child and enjoying that time with them. The other time that I notice where connection really happens on the board is when there's lots of laughter. And that might sound a little strange in a neonatal unit, but there is plenty of smiles and laughter and celebrations and little milestones and big milestones.
And often I think we think of bonding and connection as very serious, but it's often in the lighter moments that connections really deepen. It can be the same as falling in love with an adult partner. When you laugh over something really ridiculous that you feel closer to each other, and it's the same with babies.
So when babies do something very funny or very silly, and mums and dads just smile and laugh, I think that's when the connections can really deepen, and it's lovely to watch. And it feels playful, and it feels really happy. If you feel able to, you know, bathing them. Talking to them while you're changing the nappy, if you can't take them out for skin to skin, maybe just putting your hand in and stroking and just having time with them and getting to know them and letting them get to know you.
And I think just being gentle about it for yourself as well as for baby and not putting yourself under pressure for it all to happen immediately. And remembering that there will be a time when you go home and you'll be in your own space. It won't feel like the goldfish bowl that the neonatal unit is.
You'll be in your own home, your own comfortable bed with baby near you and you'll have more time. And a lot of families say that that's when they have their catch up time. So the time that they didn't get in the unit, just them as a little family unit. And that time is there for years and years to come.
So even with a full term baby, I notice, you know, with my own child, As she gets older, I go, Oh my goodness, I thought I couldn't love you anymore. And today I do. Just a reminder that yes, it's a process. And when you go home, it'll continue. That bond will continue to grow and develop. And I suppose just a final piece of advice for parents is please.
Please be gentle with yourselves and look after yourselves because if you look after yourself, then you are able to look after your baby and try not to be too hard on yourselves or try not feel under pressure to, to connect in an instant. Cause it just, it doesn't really work that way for most parents.
I'm just picking up on something you said there, Aiveen, about parents being gentle with themselves and not being too hard on themselves. And I think that's something I've noticed through my conversations with parents on the ward is this expectation that they should know everything. And then they get really hard on themselves and really critical of themselves when they haven't known something that maybe has impacted baby's care or...
They're being told that baby had blood tested and they didn't know about it, but they're in sync seems to be really hard on themselves and actually kind of put themselves down a lot. And I guess that's made me think more broadly about how can we, I guess, staff on the ward support parents with looking after themselves, but what parents might need to do as well during this really difficult time to make sure they are nurturing themselves and keeping themselves well.
Yeah, I think we all carry a critical voice. I know I do. I think it's part of being human. Some of us are a bit more self critical than others. I think as a parent, as a new parent, we have a very strong critical voice and there's probably a very good reason for that. It's to keep baby safe. We are critical of ourselves because we want to make sure baby is protected and fed and watered and kept safe.
So there is a voice in your head saying you have to do this right. You have to feed her on time. You have to make sure she gets enough sleep and it's to keep babies safe. And particularly on a neonatal unit, I think that critical voice becomes very, very loud. And it's probably because of all those feelings of guilt that parents can carry or feelings of loss.
It makes you very, very self critical. When I ask parents what they would say to another mum or another dad in the ward, they're always so compassionate. And they say, Oh, but it's not your fault and you need to look after yourself and you're doing such an amazing job. But they can't say it to themselves.
So I think what can help parents is just to recognize, first of all, the critical voice has a purpose. So don't get cross to yourself for being critical because sometimes you get into a bit of a loop, you know, I'm critical and now I'm going to get critical of myself for being self critical. So instead, instead just recognizing it.
There it is again. That voice that's telling me I need to do something more, or something better, and I know that's just about me keeping my baby safe, so you're okay, Critical Voice. You can give it a name if you like. You're okay. I have this in hand. Me and the staff have got this. We're gonna bathe baby.
And we're going to do our very best and baby is fine. So countering it that way and just trying to think of the compassion you'd have for another parent in your position and turn some of that inwards, which is actually quite hard for some people. So I'm not expecting that everyone will be able to do that, but if you can do that, turn some of that compassion back on yourself, just be really gentle.
You're doing a really good job here. This is so new. This is a really difficult place to be. And I think acknowledging that this is a difficult place to be, because a lot of parents get told by family and friends, your baby is in the best place. And they get a lot of comfort from that. And it is the best place, perhaps medically for the baby, doesn't mean that it's an easy place.
So just reminding yourself that this is really difficult. This is not what I expected. I didn't train as a neonatal nurse. So why on earth would I know the same amount of information as a neonatal nurse? I'm doing a good job here. My baby's doing a good job here, so just allowing yourself a bit of acknowledgement for how you're doing as a parent.
Just following on from what you said there about acknowledging how well parents are doing during their neonatal journey, it made me think of how important it is. Is for them to give themselves permission to feel whatever it is they might be feeling. Whether that is sadness, anger, guilt, whatever those big emotions might be that are floating around for them.
But to allow themselves time and space to feel them and to acknowledge the emotions that they're going through and to validate them. I guess I'm curious about what your experiences might be. Yeah, I think just in the same way as for siblings, we say you know, maybe acknowledge the emotions, name them and give permission, normalize them.
Try do that for yourself as well. So a lot of parents say to me, I shouldn't feel sad and upset or I shouldn't feel grief at what I've lost because my baby's here and it could have been an awful lot worse. I should feel grateful and I guess what I always say is, but you can feel both. It's not either or it's both and so you can feel both grateful.
For the beautiful baby that you have, and you can feel loss of your third trimester, or the birth you'd planned for, or the chance to breastfeed, or the chance to show your baby off. So it's okay to feel both. As humans, we're very complicated. We don't just feel one emotion at a time. So give yourself permission to feel lots of things at once, and if you can, name them.
And if you can name them for your partner as well, that can be really helpful as well, if you can see a name and wonder, and to just give yourself permission to experience those emotions. One of the things that parents have told me can help is to capture things on paper. So keeping a journal or a diary, writing down those emotions doesn't have to be in any way coherent.
You can make sense of it later, but just getting it out. Some parents prefer to speak it, so they might voice dictate it. Others prefer just to talk with a friend or a family member and just talk about what they've been through. Begin to make a bit of sense about it. Sometimes that feels way too scary for parents to do, especially early in their neonatal journey.
And sometimes it's not until after you've left the hospital that you begin to make sense of what you've been through. So we always advise parents to be prepared for that, that some of that making sense of and thinking about and wondering and reflecting on happens when you go home. It's a bit like being in a fire.
It often feels like that in the neonatal unit. You just focus on trying to get out. Get everybody out safely, and you don't really have time to sit and think about what it's like in the fire when you're in it. So sometimes it's when you're out of the fire and back home that you have the space to go, Oh, my goodness, what on earth has just happened?
So that can happen at home and you might find yourself talking a lot to family and friends about what you've been through. Another thing that parents tell me is that sometimes family and friends don't quite understand what they're going through and Also that they're not able to be available to them in the same way, even physically, just with the restrictions and who can come onto the unit.
We use the phrase, it takes a village to raise a child, a lot on the unit, and I think sometimes it's hard to get the support from your village. probably for most parents nowadays because we don't tend to live in the same space as our family that we grew up in. We may not know our neighbours and we don't always have that village around us.
And then when you're in a neonatal unit, they can't come onto the unit. They might be able to clean your house for you and do your washing and drop around food. They may not be able to be there when you're on the unit. Nursing your baby, so let the neonatal staff become part of your village just for that period of time and talk to us.
Let us know how you're feeling, let us know if there's anything we can do, whether it's bringing you a drink, or encouraging you to go and have a cup of tea down the canteen, or whether it's a chat that you want, and remembering as well Psychology is there for exactly that, for support, and if you need to talk, if you want to make sense of, if you want to let out difficult emotions, that that's what we're there for, and you just need to give a shout, and we're never too far away.
One of the things I've noticed, Lauren, that you always pick up on, and I sometimes miss, is looking after your basic needs, and that sometimes it's not about talking, and sometimes it's just about making sure that your basic needs are met. Yeah, I think you mentioned earlier about how it can be quite lonely for parents when they're on the unit, and also sometimes it can feel like really, really long days for them.
I'm always quite mindful of trying to gently encourage them to maybe go get some food from the canteen so they can get the meal vouchers from the nurses. and just have a bit of time for themselves to kind of rest, recover, refuel, make sure they're fed and watered. I think sometimes whenever we are in really difficult and challenging and unpredictable situations, it tends to be our basic needs that tend to get overlooked and that might just be the way that we cope and that can be okay for some people if that's what they need to do.
just to get by, but often if we can pay a little bit of attention and give ourselves some of that compassion and nurturing that we're given to baby and siblings and parents and grandparents and everyone around us, it can mean that, then, we're in a better place to keep giving that. So I think for me, it's really important to encourage and make sure that parents feel like they are being looked after and their basic needs are being met so that they then feel in a better place to be able to connect with baby and bond with baby, and to get through their time in the neonatal unit.
So Lauren, we're coming near the end of our talk and I am going to throw a curveball at you and I'm going to ask you what it is you love about the unit because I can see from your face when you're on the unit how much you love it, like me. So what is it that you really love about working on the neonatal unit?
I'm going to have to pick a couple of things because I could probably talk about it for a whole podcast. But I think one thing is seeing the babies grow and develop and thrive. And something we've talked about is. That they can seem, and they are, really vulnerable and really fragile, but to see them grow and develop and actually become quite feisty and resilient is such a lovely thing to witness and such a privilege to be able to witness that.
It's also lovely to be able to provide support and a safe space for parents, whatever that might look like for them, is such a privilege, and to be able to provide reassurance, advice, comfort, or just a space where they can cry. about what's going on for them, or express those difficult emotions is really refreshing.
And it's lovely to be able to provide that psychological support to people in a way that feels different from traditional psychology that I'm used to. So it challenges me to develop and be more flexible. But I also. I think it helps me to work in a really person centered way, so you're definitely led by the parents and you're absolutely led by the babies, and it just is such a lovely experience of...
provide in psychology that's different to anything I've, I've done before. 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. On our next episode, we will be joined by someone with firsthand experience of a neonatal unit.
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.