The day a NICU family goes home from the hospital, without the weight of their new baby in their arms, is a day not easily forgotten. I still remember the morning I left the hospital after my son’s preterm birth: with a commercial breast pump, a NICU wristband and no baby. Ten-weeks, several blood transfusions and a minor surgery later… I finally brought my baby home.

With all of the ‘how to’ about childbirth and parenting circulating online and in our communities, it is almost shocking we don’t share in equal measure what happens after coming home alone – baby-less – or what happens when you do everything ‘right’ according to ‘experts’ and your birth still unfolds in a way never anticipated.

This is where support from a Postpartum Doula may have a major impact on providing emotional support for families. We are present as non-medical, non-judgmental support. We provide evidence-based information, emotional support and referrals for the entire family. We mother the mother and educate the family in the best ways to nurture themselves after the birth of their baby.

A turning point for me during the first week home after my son’s birth, was when my Birth Doula came over and we watched a video together about Kangaroo Care. I hadn’t even held my son yet, but I remember the hope I felt inside when the video ended.

Common concerns and questions from NICU Families:

How may a mother recover from her birth while attending to the needs of her infant in the hospital?

How may the family and newborn bond when they pass so many days and hours apart from one another?

Will my baby know me when the nurses care for them so many hours and I only visit?

Must I visit my baby in the hospital every day?

Will I be able to breastfeed? Do I have to breastfeed?

What happens when I bring my baby home?

These are questions that may be answered in a myriad of ways.  As Doulas, we guide families to the resources which; support their decision-making, feelings, ideas, beliefs and goals as a family.

1. One of the first ways we may support families in finding these answers is by offering them peer-based resources. This might be an online support group where they ask questions: a podcast, book or other resources where NICU families, past and present, communicate and share their experiences. This will help families recognize they are not alone in their journey.

2. NICU mothers are at higher risk for postpartum depression. This makes it vital to educate them and their families about the risks, signs and symptoms of depression. As well as, what signs might indicate a need to speak with their doctor. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4247145/

3. Kangaroo Care is beneficial for both parents and baby. Having a folder of evidence-based articles to share or links to videos about skin-to-skin and how it nurtures bonding and breastmilk supply may be uplifting to new parents. Articles are especially supportive for a family who hasn’t held their baby yet or a new mother who is trying to pump more milk.

4. For families who are choosing to pump and/or breastfeed, offering them information about when to pump, how to care for their pump, as well as, maintaining their milk supply, is beneficial. When we are present for these moments in the early days, this provides an immense amount of emotional support. It’s often in these moments while pumping in the middle of the night, families remember why they’re pumping and miss their baby from whom they are separated. There are often Lactation Consultants who rotate through the NICU when babies are ready for nutritive feeding at the breast. Families who are lucky to receive great nursing care during their stay also may receive support with breastfeeding.

When my son was in the NICU, I felt very unsupported by the Lactation Consultants on staff.  Luckily my pediatrician sent his IBCLC to the hospital to support my son and I with latching. For families feeling unsupported by the NICU Lactation support on staff, Doulas may educate them to the extent of our scope and then refer them to an IBCLC as needed. As NICU mothers, through medical necessity, it can often feel like we have been usurped of the primary caregiving of our infants. For mothers choosing to breastfeed, succeeding in this endeavor, may be a major confidence builder. Providing breast milk to our infants and nursing them when they’re able is a role we have, that no one can substitute.

The NICU is a roller coaster. When you feel like you’ve got your bearing, something else comes up. One would be hard pressed to find a past NICU parent who hasn’t felt this way. Even if their baby were only there for 24-hours. NICU parents aren’t protected from witnessing the weariness of other families who may be having a more challenging time. There are many direct and indirect stresses and traumas and the global Covid-19 pandemic has only added to this strain. Most NICU’s are only allowing two ID wrist banded persons to visit. No in/out privileges and mask wearing at all times. Hospitals are taking temperatures at the doors and there aren’t parental sleep rooms. Though parents may still ‘room in’ at the end of their baby’s hospital stay and NICU’s with private rooms still allow wrist banded persons to stay in the rooms.

For families anticipating a NICU stay, they may find out what their hospital NICU protocols are ahead of time. For families who are unexpected guest at the NICU, they may speak with their assigned social worker or ask their nurse about the protocols for visiting.

In Los Angeles, California where I reside, at the onset of the Covid-19 lockdown, many laboring families were unable to have a birthing partner and labor support person at the hospital. As it stands now, October 2020, many local hospitals have now revisited this policy and are allowing Doulas to support families in the labor room.

The pandemic has created a lot of panic and caution within families. Due to isolation and the inability of extended family members to provide proximal support, it has only created more demand for labor and postpartum care Doulas provide. I have many colleagues, including myself, who have begun to explore and provide Doula care to clients virtually via video, text and phone. In providing this type of service, I believe, in the absence of our physical presence, we can never be too far away to give our emotional all. Notwithstanding, being in the same room, we are still connecting and able to respond to parents any time to support their family’s wellbeing. During my son’s hospitalization, one of my greatest comforts was being able to reach out to my pediatrician 24/7. When a family is struggling or needing guidance, we may not physically be there, but being able to hold space for them is impactful.

As Doulas, we are chosen companions for families during a very special time in their lives. They often look to us for our personal opinions and answers. If we can remember to meet them where they are and guide them to the resources enabling them to trust in their intuition, we will be doing our families a great service.

For NICU families especially, this incredible time in their lives, may turn into weeks and months fraught with uncertainty. Their babies are being cared for round-the-clock by medical professionals. As Doulas, we are the trusted person parents have invited to be present as they welcome a new baby. Doulas may be one of a handful of steadying, supportive presences during the pregnancy, birth recovery, NICU stay and the early days home with the baby.

By leaving our preconceived ideas, personal opinions and anecdotal advice at the door; by embodying our Doula roles in their fullest potential, we bolster the confidence of our community and parents and provide an immeasurable, intangible familial support which will reverberate for many years as they grow into a more mature family and communities grow.