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Welcome to The NICU Translated Podcast, where we break down the complex world of the NICU into clear, relatable insights for families and the professionals who support them. Hosted by Mary Farrelly—a certified NICU nurse, doula, and educator—this podcast is your go-to resource for navigating the NICU with confidence and compassion.
Whether you’re a doula looking to better support NICU families, a healthcare professional seeking deeper understanding, or a parent preparing for or living through a NICU journey, you’ll find actionable tips, evidence-based guidance, and heartfelt stories to inspire and empower you.
Each week, we’ll explore topics like:
-NICU 101: Terms, diagnoses, and medical equipment explained.
-Preemie care basics and developmental milestones.
-How to advocate for your NICU baby with confidence.
-Emotional and trauma-informed support for NICU families.
-Insights from NICU professionals and families who’ve been there.
With episodes featuring expert advice, list-style guides, and real-life interviews, The NICU Translated Podcast is here to equip you with the tools and knowledge to make the NICU journey less overwhelming and more empowering.
Subscribe now and join our community dedicated to bringing more joy and less trauma to the NICU experience—because the NICU is only the beginning.
Let’s navigate this journey together.
Mary Farrelly (00:00)
If you've been listening to this podcast for a while, you know that my heart lives in the NICU. I've worked inside a level four NICU for years. I've cared for babies born at 24 weeks. I've supported families arriving at 2 a.m. after emergency transfers. I've been a bedside nurse, a charge nurse, a nurse educator, and everything in between. And I've seen miracles, like real miracles. Babies who shouldn't have survived thriving, families who were shattered start to rebuild.
and teams that work with extraordinary skill and true passion and dedication. NICU Medicine is truly incredible. And at the same time, I've also seen where the system cracks. And this episode isn't a criticism. It's not a takedown. It's not an us versus them conversation. It's more of like an evolution conversation or maybe even a quiet revolution. As we close season one of the NICU Translated podcast, I want to talk about the future of NICU care and what it would look like to truly rehumanize it.
Mary Farrelly (01:31)
Hi friends, welcome to this week's episode of the NICU Translated podcast. This is an extra special episode because it is the last one of season one. Season one has been an incredible journey. I've met so many just magical people doing incredible work in and around the NICU space and it has been such an honor to share their conversations and I can't wait to see what season two brings.
But on this final episode of season one, I wanted to take a moment to pause and reflect. I have done in these dark wintertime months, some deep thinking and big picture vision planning for both what I want the NICU translator to step into as a company and as a business that is making real change in the NICU, how I see myself evolving potentially even as a thought leader and someone who can
step into the spotlight in a different way as a voice for this next step in NICU care that I truly believe ⁓ is the future of NICU care, both before, during, and especially after NICU stay. So bear with me, and we're gonna kinda go deep into my vision for what this could be. And again, this is just some ideas, and there's so many incredible things that are already happening.
⁓ And as we know, there's always room for change and for improvement. So one thing that we know the NICU does incredibly well is the NICU was built for survival and it does survival extraordinarily well. We have ventilators that can support lungs the size of grapes. We have protocols for conditions that literally did not exist decades ago. And we have highly trained, highly skilled teams that can respond in seconds. So the level of
medical innovation in the NICU is truly unmatched. Like it is such a unique specialty. And one of the reasons why I was drawn to it to begin with, and also why I stayed for the duration of my bedside nursing career in the NICU is because of this extraordinary specialized skill in medical care and this commitment to evolving and to doing better. So for example, when I first started at bedside care over a decade ago, the
minimum age of viability for babies was 23 weeks. And those babies were still very, very fragile and tenuous. Now we resuscitate babies as low as 22 weeks and sometimes even in the 21 week gestational age window. And the level of care that we can provide and therefore the survival rates and the outcomes for these babies is literally improving every single year.
So the system is built and optimized for medical stabilization and clearly does this well. What the NICU is not built for or does more as an afterthought is emotional stabilization and relational integration and even some provider sustainability. So really remembering that the NICU is a special space where humans are taking care of humans.
And this is not unique, that aspect is not unique to the NICU. That is a core tenant of healthcare. And I feel like when we forget this piece of the puzzle is sometimes where you can have compassion fatigue, burnout, feeling like a cog in a wheel, ⁓ profit over people, that kind of mentality. But I truly believe that the NICU is extra special because the NICU is not just an ICU. And yes, it is an ICU.
but it's also a sacred space where parents are meeting their baby for the first time. That is very unique. That is not what is happening in an adult ICU or even in a pediatric ICU. The NICU is this incredibly important time in both a family and a baby's journey through life. And it is in the NICU, it is a space that's happening under fluorescent lights and surrounded by alarms.
It's also where grief and hope are living at the same time. So even if there is a lot of overwhelm and grief in a NICU setting, it is still a place where, again, parents are celebrating a new life and they're meeting their baby. So there's always this underlying element of hope. And because of this unique kind of liminal space that the NICU lives in, it's also where trauma can...
really quietly embed itself, even in good outcomes, even in those, you know, easier quote unquote, NICU stays where the baby has a fairly uncomplicated course and goes home. The trauma of having this sacred
happen inside of an incredibly medicalized environment is in itself a trauma for many
So
because of the ICU setting and because of the intensity of care that the medical team is
units, the culture kind of becomes this, well, we're not a hotel. We're here to do a job, which is true. The NICU and a hospital is not a hotel. And this is especially true in many adult units. But this is this uniquely human experience.
And this is the part that we don't like say aloud often enough. Even if we're ignoring that piece of the puzzle as care providers, as NICU doctors, nurses, and other specialized providers, that reality is still there. So instead, the incredible emotional labor of supporting a family through the transition that is matressence and stepping into parenthood and meeting their new child, a new life for the first time, this kind of
emotional toll then falls on top of the especially the current model of care on top of the health care providers. So as nurses and doctors and other providers we're holding for our families and for our patients incredible fear, trauma, loss, this sense of fragile hope. And then we're also expected to do this for 12 plus hours straight. Sometimes without caring for ourselves, without eating, without sitting down, most of the time without processing what is happening to us. And then we're just expected to
come back and do it again and again and again. And so this sense of compassion fatigue becomes incredibly normalized. People who, you know, the new guys that I hired as a nurse educator would come in with these sunshine and rose colored glasses and this sense that they could help everyone and slowly, sometimes not too slowly, sometimes quickly over time, this sense of compassion fatigue becomes incredibly normalized and this feeling of martyrdom
becomes almost a badge of honor. Almost saying, as a healthcare provider, know, I don't need a break. I didn't eat till 4 p.m. yesterday. You know, that family is just a difficult parent. That's one of my least favorite statements that I used to hear coming on as a NICU nurse at the bedside is, ⁓ like, you know, watch out, Mary, this family is really difficult. They're really hard family.
and I would always just kind of smile and be like, I speak, you know, I speak crazy fluently, like, and that's okay. But it's because the system itself is squeezing providers dry. We're expected to both deliver this clinically excellent medical care, which is a full-time job in itself, and also provide this incredibly heavy and sacred emotional care and support of a family at this incredibly vulnerable point in their life.
And so instead of seeing the incredible burnout that medical team and care providers are under, we kind of protect ourselves by hardening or maybe going to dry humor or dark humor or kind of compartmentalizing and not allowing yourself to care because of the system that you're in. You are literally not.
getting breaks and you're not taking care of your own bodily needs, much less your own emotional needs as someone holding space for people with emotional needs. But when providers harden, families can really feel it. So no one is the villain here at all. Like we're all just, again, people stuck inside this very kind of tenuous system that is kind of functioning, but has so much room for
improvement in the sense that the trauma that everyone is feeling, the babies through the care that we're providing and the capacity of both the hands-on care providers in the NICU and the families, the families themselves who are leaving the NICU with extraordinarily high rates of PTSD. Up to 40 % of NICU families experience clinical PTSD symptoms within the first year after discharge.
And also then the healthcare providers who are holding immense secondary trauma, which can often again manifest in burnout and poor retention and turnover in hospital staffs. So no one is the villain here, but the structure was built just for survival, just for quote, getting through the day. You might've heard this as a NICU nurse, I'm getting through my shift, but that's just the same cycle over and over again. It's not this step back overall big picture vision of
wholeness and what this actually could look like. So one of the things I also talk about a lot in my teaching in Nicky Dill Academy and other courses and something that's really stuck with me when I first started learning about it several years ago is this dynamic that often plays out in high stress systems. And it's something called the drama triangle. I did not invent this. I will give credit in the show notes to ⁓ the person who initially presented this in their research and literature. But in the drama triangle, there is a rescuer.
There's a victim and then there's a persecutor. And you might, as I start talking about this, might hear this kind of play out in your own life in different instances. This is not just unique to the NICU, ⁓ but in the NICU specifically, oftentimes the medical team can see ourselves as the rescuer. People who get into helping professions, especially like medicine or doula work, tend to have this personality.
core value about helping people, which is a beautiful, beautiful
But the undercurrent of having a rescuer is that there's someone that needs to be saved. And so oftentimes in the NICU this would become the baby, which is someone who truly does need to sometimes be rescued, saved, cared for because of their unique developmental medical needs. But then often the parents become this kind of
victim role as well too because they feel incredibly overwhelmed and also incredibly powerless in a system as it is currently designed. And then in this sense, and one thing that we can kind of agree on is the system, the pressure in the system becomes the persecutor. Sometimes in the NICU this drama triangle can shift where the hospital care team and providers become the persecutor, the family still stays in the victim role, and then sometimes a doula or other
family member can see themselves as the hero or the rescuer that can kind of come in and quote save the day. And so without the right support, literally everyone gets stuck in these reactive roles. People who feel like they are being seen as the persecutor can feel really defensive. Like if you feel like you're the bad guy as a nurse, just quote unquote trying to do our job, it can feel really overwhelming, especially if you haven't taken the time to kind of reflect and think about.
you know, why is this dynamic playing out? Like what part am I having in this situation that is at our, you know, in front of our face, just depending on what it is. And then also
the parents in this situation by feeling like victims, they feel like they don't have a say or autonomy as a parent. So there are ways to shift this dynamic from the rescuer to more of a coach and a support person. But this again is probably not going to be the capacity or the role of a medical provider in any given setting. Their main support still needs to be
the clinical care of the intensive care unit patient, which in this case would be the baby.
But here's the truth about this situation. Parents are not interruptions to care. They're truly part of the care team
providers are not machines. We are not infinite wells of resilience and care. They are human beings. So if we want the NICU to continue to evolve, we have to honor both of these truths at the same time. And one of the buzzwords that's been thrown around in NICU care,
for the past decade or so is this concept of family-centered care. And there has been incredible, incredible changes and strides in bringing the family more to the center of the care team. But again, the emotional burden and the toll and the capacity for a medical team to take on this role of mentor and coach of a family member while also delivering clinical medical care at a time when the family is postpartum, which has its own levels of
hormonal changes and physical changes and there's overwhelm and psychosocial changes and financial strain. Everything is this like melting pot in this one unique setting. So what does rehumanizing the NICU actually mean? It doesn't mean less medicine. It doesn't mean fewer protocols or lowering standards. It means adding additional structure and breathing space for bringing the humanity back to the bedside. It means that trauma-informed training that isn't like a one-hour checkbox.
is like an actual integrated philosophy into how the NICU is supporting the entire family unit. And it also
means how the NICU is supporting the entire family that is the care team as well. So this might mean structured emotional debriefing for staff after difficult cases. It means staffing models that actually allow for relational presence.
not just checking boxes and completing tasks. It means coaching parents instead of excluding them. It means recognizing that provider sustainability directly impacts patient outcomes. If you have a burnt out nurse caring for a baby, you are not going to have the same clinical excellence that you are hoping for.
It means creating units where vulnerability is not a weakness. This is something that I see and saw all the time as a nurse educator is this concept of nurses eating their youngs, which means that a new hire nurse will come on, a brand new quote unquote baby nurse, and the older, more seasoned nurses have this mentality of needing to toughen up these nurses and have that martyr complex that I referred to before.
where any sign of vulnerability or
is seen as something that needs to be fixed or removed or this person is just quote not cut out for the NICU. Whereas in reality, those are the people that
are needed to balance the more hardened clinical excellence that some nurses bring. There is a balance and there's a beauty and we all serve different purposes and different gifts in the NICU setting.
It means that a new nurse being emotional doesn't mean that she's unfit. It means that she is human. And
we don't need to tear the NICU down, right? We just need to evolve it because the NICU is truly sacred work. And when you are, as a bedside nurse, when I had those shifts where I was able to recognize the sacredness of my role and also had space in my shift to serve in the capacity that I knew I was capable of, that is when I felt the most
peace and purpose in my position as a bedside nurse. Because the NICU is truly sacred work and sacred work deserves sacred structure.
Mary Farrelly (17:43)
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Mary Farrelly (18:26)
So this is also where NICU informed professionals, especially NICU doulas, can fit into this future model of NICU care. So NICU doulas are not replacements for nurses at all. They are not critics of medicine. They're not hospital adversaries. They are truly a bridge. They are that person that can
fill this gap in emotional regulation of families. They can help parents process complex information. They can protect the parent-baby bond during these moments of crisis and can even extend continuity from the hospital to home. So importantly, when this is done well, they should be reducing provider burden, not adding to it. Because when families feel supported and informed and regulated, literally everything can flow better.
And NICU duals don't compete with medical care. They complete the circle around it. They're part of a broader movement of NICU-informed lactation consultants, therapists, social workers, and developmental specialists. Professionals who can truly understand that this experience does not end at discharge and that these families and babies have had a very unique experience that requires a different angle and a different lens of care, especially after the NICU experience.
One of the common myths that I hear all the time is that the NICU ends a discharge. the baby's home now. Everything is back to normal. But we know, especially if you're a NICU family listening to this, that that is simply not the case. Although the actual clinical care of the NICU does end a discharge. You can't bring your NICU nurse home. Although sometimes families can feel like they're bringing a lot of elements of medical equipment and care home with them.
What doesn't end a discharge is this lived experience and and framework that these families stepped into their role as parents within.
So I envision a future where every single NICU family has access to trained support from the time of admission the transition to home. Where emotional care is structured as intentionally as medical care and where trauma-informed practice is standard. And nurses can be also in this model supported as whole humans, not just a warm body that shows up for a shift, does their job, checks their boxes, and then goes home. And this allows families
not just to leave with a discharged baby, but with true tools, actual confidence, and dignity intact. And the goal with all this is to, again, decrease trauma, which trauma is kind of a buzzy word, but to me, trauma is the idea that the event has lingering ripple effects throughout.
the family and the baby's lifetime that goes well beyond anything that we are even imagining during our care at the bedside. So what can you do right now? If you're listening to this and you're like, yes, I see the vision, I see the gaps, but how do we actually make the change? Because one of my most frustrating things when I was at the bedside is when people were sitting around and saying,
Complaining basically going around like oh, you know, we don't have enough time for breaks or oh, I hate how this You know, where are this we don't have enough supplies of whatever it is It's one thing to complain and that's fine. That's how we see our problems But if you don't do anything about it Then my my whole thing is you're not allowed to complain if you don't have an idea to how to help solve the problem I don't want to hear about it, which is a little harsh, but it it really is important to think. Okay, here's the problem what
can we do to help fix this? And this is not like something that's going to be quote unquote fixed overnight. This is going to be a series of slight shifts, ⁓ conversations, changes in culture, adding new faces like NICU doulas is onto a care team. But if you're listening to this, what can you do right now? Because you don't have to, we don't have to change it all overnight. This is going to be what is the next best step that I can take towards the shift towards this new vision of truly humanized
NICU care. So if you're a parent, one of the most important things that you can do and so many of you do it so well and have done this on the NICU Translated Podcast is share your story. One of the barriers to getting support for NICU care is the lack of awareness. As many of you know, unless you had a NICU say, you probably did not know much about the NICU before the NICU became part of your story. This is another thing that I'm passionate about changing is bringing more
understanding and light education about the NICU to every single pregnant person so that if and when the NICU becomes a part of their story, they have the tools and the capacity to help navigate it. in order to make those changes, we need to start sharing our stories. You need to be able to ask for trauma-informed resources and advocate for structured transition support. Normalize needing emotional care alongside medical care. The most important place is that we can share our stories.
are to each other, but also to the people that are within the system themselves, to the doctors, to the nurses, to the care providers, so that we can really see the humanity and hear the individualized stories that are a part of the
driven model of care that we are living. If you're a nurse, right now, the most important thing you can do is protect your own sustainability, because as we know, the systems right now are again, not shifting overnight, and they have incrementally, definitely improved over the last decade.
But we need to continue to have our own practices that allow us to sustain the care of the families that we are honored to share their most vulnerable moments with. But this allows us to also protect our ability to show up for the next families and the next family, the next family after this.
We can invite collaboration instead of resisting it, really inviting families into this space. Oftentimes that is just a simple conversation and an acknowledgement that what they're doing is incredibly hard and that they are doing the best they can with the resources that they have. We can advocate for debriefing spaces and having these conversations and allowing people to be vulnerable with the impact that their care of these families has on their own personal
life and ability to sustain emotional care. Recognize that system change starts with awareness. That is literally the first step is having these conversations, pointing out little moments of like, maybe she's not difficult. Maybe she is experiencing a traumatic event and this is how her trauma response is manifesting. These little kind of cracks in a very, very armored system is where we're going to start shining the light in.
If you're a doula or professional or someone who already is supporting families, the first thing you can do is get NICU informed training. order to be, the NICU is a very unique language. It is a very unique environment. It is a very unique space and journey. And in order to support families and help them build their advocacy skills and help them navigate the complex system that is currently existing, you really need to have your own NICU skills and training to be able to support families in this unique setting.
You can also focus on building partnerships, not opposition. Again, going back to that drama triangle, if people in care teams are seeing doulas as an adversary, as an us versus them mentality, we're not gonna get anywhere. No one is going to respond. If someone comes at you, beeping their horn and flicking you off in traffic, you're not gonna be like, let's have a nice conversation about how your actions in traffic is affecting me and my family. It has to come from a place of curiosity.
and collaboration. And this is partly also like respecting these sacred spaces you're stepping into. We talked about how the NICU is a sacred space and there are so many aspects of this sacred element that Doulas can bring into the NICU, but we need to respect and recognize the incredible value and work that the medical team is doing to
allow these babies to survive, not just thrive. We still have to survive in order to get through the NICU experience. One of this might look like learning hospital culture before entering into it and then helping to support families again in ways that reduce friction, not add to it. And if you're a leader listening to this, especially in the NICU setting, one of the things that we do and there's a shift towards it is measuring the family experience alongside medical outcomes.
and investing in relational care. might look like spending time on a family advisory board meeting, inviting families back to the NICU to share their stories with your, not just with you as a leader, but with your team and recognizing that emotional stability for your staff leads to long-term improved health outcomes for the babies, for the families and for your team members. So this is not exactly a revolution. It's more about a maturity.
⁓ and evolution and really next steps into how the NICU can evolve into this truly optimized and incredibly special place that we already know it is and allow for even more miracles to unfold. So as we close season one of the NICU Translated Podcast, I want to take a moment to truly thank you from the bottom of my heart for being a part of this conversation.
The podcast started as a way to translate the NICU, but it's becoming something more than that, which is both exciting and a little bit scary to a certain extent, stepping into this new space. But it's becoming this space where we can really imagine what NICU Care can evolve into. And season two, we'll continue that conversation with more voices, more bridge building, and more innovation.
So the NICU will always be a place where tiny lives fight big battles, but miracles don't only happen through ventilators and IV pumps. They happen in connection. They happen in trust. They happen in presence. And the future of NICU care is not less medical. It is simply more human. And we are just getting started
because the NICU is only the beginning and together we can make this journey less overwhelming and a lot more empowering. NICU love, love, Mary.