Things to Know About the NICU Before Going Into Labor

The majority of babies born with medical or surgical problems need to get admitted to a neonatal intensive care unit (NICU) after they are born.  There’s a common belief that NICUs are full of preemies, which makes total sense, since 1 in every 10 babies born in the U.S. is premature.  But the reality is that many NICU patients are full-term (≥ 37 weeks’ gestation).  On any given day in the NICU in which I work, about half of my patients are preemies and the other half are born right around their due dates.

The most common reasons that babies have to get admitted to NICUs include prematurity, birth defects (often involving the heart, kidneys, brain, and/or digestive system), breathing problems, metabolic problems (including low blood sugar), dehydration, infections, seizures, other neurologic issues, genetic syndromes, delivery complications, withdrawal from medications, and severe jaundice. 

Most NICU admissions end up being a huge surprise, as many of these problems, including infections and breathing problems, cannot be predicted ahead of time. If your baby is born with any of these issues at a hospital that does not have a NICU, he or she will need to be transferred to a hospital that has one. In some cases mothers are able to be transferred when their newborns are transferred, but this is not always possible. Mothers cannot be transferred if they require close postpartum monitoring by their obstetric teams and/or are not medically stable enough to leave the hospital they delivered at.

It’s also important to consider delivering at a hospital with a NICU so that a team of newborn specialists will be able to come to your delivery at a moment’s notice if there are any complications. The most common reason that NICU teams get called to delivery rooms is to assess and resuscitate newborn babies who are having difficulty breathing. Although all hospitals with obstetric services have personnel who are certified in newborn resuscitation, they usually do not have as much education and expertise in taking care of sick newborns as NICU teams of doctors (neonatologists), nurses, and respiratory therapists do. 

Almost all NICUs encourage parents to be with their babies as much as possible and allow parents to visit 24 hours a day, 7 days a week. An increasing number of NICUs have amenities so that parents can stay overnight in their babies’ rooms, including beds, refrigerators, and bathrooms. Many parents worry about getting in the way of their babies’ NICU nurses and neonatologists, but this is never the case. One of the most frequent questions parents ask me is, “How can I participate in my baby’s care in the NICU?”  

Ways that parents can participate in taking care of their NICU babies include all of the following:

  • Be present in the NICU as often as you can. Talk to, sing to, and read to your baby.
  • Do “kangaroo care” with your baby on a regular basis. This means holding your baby skin-to-skin on your chest while sitting in a comfortable chair. Kangaroo care keeps babies warm, helps to stabilize their breathing and circulation, and increases the amount of milk moms are able to make.
  • Start to pump breast milk as soon as you can after your baby is born and begin to breastfeed your baby when he or she is stable enough to orally feed.
  • Participate in your baby’s care when you are there. This includes diaper changes, clothing changes, taking vital signs, and giving baths.
  • Get to know all of the doctors and nurses who are taking care of your baby. Being able to openly communicate with our NICU parents helps us to take the best possible care of our newborn patients.

Although no one wants their baby to have to go to an intensive care unit after they are born, it is something that can happen after any delivery. In some cases mothers know that their baby will have to go to the NICU ahead of time, but most of the time this is not the case. I encourage all expecting parents to consider delivering at a hospital or birthing center that either has a NICU, or is very close to a NICU, in case complications arise and a neonatal specialty team is needed to take care of your baby.

Jessica Madden
Jessica Madden
Dr. Madden is a board-certified pediatrician and neonatologist who has been taking care of newborn babies for over 15 years. She is currently on staff in the neonatal intensive care unit (NICU) at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. She also provides in-home newborn medicine and lactation support to new mamas and is currently working to become an IBCLC.

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