Having a baby in the Neonatal Intensive Care Unit (NICU) comes with a wide range of emotions and experiences that can be challenging for new parents to navigate. And many feel like they’re facing this challenge alone.

The founders of NICU Nook, Dr. Stephanie Simon and Amanda Neilan, are working to change that!

This episode is filled with encouragement and support with expert advice and practical strategies to help you and your baby thrive. You’ll learn strategies for navigating the NICU and cultivating a secure attachment bond that will endure beyond the hospital walls.

Dr. Stephanie (00:00):

There’s so many providers in the NICU that it’s such a common experience for parents to think, what is my role here? What is the point of me even being here? And what we try to emphasize is that only a parent can provide warmth, affection, love, and care that a parent can provide. It’s its own form of medicine.

Dr. Sarah (00:26):

Having a child in the NICU is a situation no parent wants to find themselves in. Not only is it a time filled with overwhelmingly difficult emotions, but it’s often filled with a sudden emergence of medical jargon, confusing decisions, and scary what ifs. Today’s guests are working so hard to provide support to these NICU parents who so desperately need it together. Dr. Stephanie Simon, who’s a licensed clinical psychologist, and Amanda Neilan, a board certified pediatric nurse practitioner with over nine years experience as a neonatal intensive care nurse, have teamed up to create NICU Nook, an online course that guides parents through each step of their NICU journeys, whether you are expecting and you want to make a plan, should you find yourself needing a NICU stay or you’ve been a NICU parent and are still processing that experience. This episode will dive into what it can feel like to have a baby in the NICU and the supports that are available should you find yourself there.

(01:29):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology, and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting and insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(02:04):

Hello everyone. I’m super excited to introduce our guest today, Dr. Stephanie Simon, Amanda Neelan. Thank you guys so much for being here. I’m, I’m really happy to have this conversation with you guys.

Dr. Stephanie (02:17):

We’re excited too. Thank you for having us.

Amanda (02:18):

Yeah, thank you so much. We’re really excited to talk about NICU.

Dr. Sarah (02:22):

You get passionate about stuff. And so that’s actually a good segue. How did you guys come together, you guys, so one of you is a psychologist, one of is a board certified pediatric nurse practitioner. Did you guys know each other before you started working with families around NICU support?

Amanda (02:45):

Yes, Stephanie and I have been best friends since high school and we’ve just been best friends ever since. Once I graduated undergraduate, I did nursing as my bachelor’s degree. My first job was as a NICU nurse at Mount Sinai Hospital in New York City. And Stephanie, your postdoc, your not your postdoc. You did…

Dr. Stephanie (03:10):

In my doctoral training, my dissertation, I was actually on creating a group therapy for parents of babies hospitalized in the NICU who were experiencing post-traumatic stress, depression or anxiety symptoms. So we had these, this shared interest

Amanda (03:32):

And who at that time I feel like Stephanie would ask me, Hey, what does this mean? What does trophic feeding mean? Or a medicalized NICU term? And I would offer my support there and I would ask her questions about how to handle a family going through a particularly difficult time based on her expertise. And we always had a fantasy of starting her own business together. So I think the stars aligned and we saw this opportunity to combine our shared interests and passion and experience

Dr. Stephanie (04:02):

And we work really well together. So that also helps.

Dr. Sarah (04:05):

That’s super important. But you come at this, this issue and it’s different for every family, but if you have a kid in the NICU, it’s a really hard time period. And whether you knew it was going to happen or it’s completely blindsided you, it’s a really stressful time. And it sounds like you guys are both coming at the support of families who are going through a NICU experience from totally different angles and areas of expertise, but they’re really synergistic.

Dr. Stephanie (04:35):

Absolutely. So we provide tools and techniques to really, I mean for the purpose of the spot guest to establish a secure attachment and a bond with your baby from an emotional standpoint. But also so much of the uncertainty that comes with being a NICU parent and this sort of just unexpected sudden experience. What Amanda provides is certainty around what to expect from the NICU environment and from these medical terms that are really unfamiliar and just thrown into an experience that most parents know nothing about, understandably so we come at it from these two angles that really work together. They do, they should in a hospital system, but we provide it for parents so that from the comfort of their own home or at bedside they can watch our videos.

Amanda (05:32):

Yeah. And I would say as a NICU nurse, obviously a big part of my job is providing direct nursing care to the babies, doing their vital signs, changing their diapers, administering medications, but also our secondary patients are the parents themselves who are at the bedside most of the time. So my time as a nurse is really almost equally split between providing direct patient care to the babies and also providing emotional support to the families. Less so from a therapy directed standpoint, but from orienting the families to the nicu, telling them what the daily rhythm is, what to expect, and how to get hands-on. Because even having your baby in an incubator or we call ’em an isolette in the NICU, is a physical barrier to getting involved. And as a nurse, you’re kind of the bridge between the baby and the parent and you want to help foster that bond. And I try to always involve parents in the care and give them tools and techniques and the confidence to get involved and do that.

Dr. Sarah (06:38):

Yeah, so it’s interesting because we talk a lot about on this podcast, the intersection between child mental health and parental mental health. They don’t exist in isolation of one another. They’re interconnected. And so when your family system is going through a collective crisis when a new baby is in the NICU and that that’s obviously puts a strain on the baby, it puts a strain on the parents and then it puts a strain on the family system, the parent-child relationship, that bonding with the baby, the ability for a parent to feel connected, to stay out of a panic and fight or flight and threat mode and into an ability to be a safe and connected presence for the child. Because understandably, if you are going through a ton of anxiety and stress and fear, it’s hard to get into that kind of parasympathetic nervous system space of safety, connection, comfort because it’s super hard. So I’m curious, obviously there’s only so much you can do in the moment, we’re just kind of trying to survive. But what are some things parents can think about with respect to do you putting on their mask first, their air mask first they have to figure out how to manage their stress and their fear and their trauma around this in order to help establish some safety with their kid. How does that play into all of this in your guys’ mind?

Dr. Stephanie (08:26):

Well, I think first I think what you said about sympathetic nervous system arousal is so prevalent in the NICU, particularly given that it’s not only an unexpected experience and it’s scary and shocking, but also it might have come after a traumatic birth and delivery. And the alarms, the beeping sounds of the monitors are like they’re always happening. They’re the background noise of the NICU and they can become associated danger even though there’s might not be a threat of danger. So we actually talk a lot about incorporating tech and a lot of parents don’t know that their sympathetic nervous system is on high or when it’s happening, they don’t even know what’s going on. So we talk a lot about that in our course and the importance of focusing on providing soothing grounding. We actually walk through soothing and grounding techniques and challenging, unhelpful thinking that can result in anxiety and fear.

(09:40):

And I think what we try to emphasize is that there is no sort of perfect amount of time to spend in the NICU because the NICU is a stressful environment and it really can be a stressful environment. So there’s a balance and it’s all, you’re always striving to create a balance between fostering that bond and providing caregiving to your baby and taking care of yourself. And if that means taking a break from the NICU for a few hours for a day, that’s okay if it means taking care of yourself so that you can engage again, not as an avoidance strategy.

Dr. Sarah (10:22):

Yeah, because I imagine, I’m curious, what do you guys see are some of the patterns that come up with, you’re alluding to one, which is a parent perhaps thinking I’m supposed to be here at all moments of all the time, otherwise I’m failing my baby, the pressure that parents could put on themselves. Are there other things that you tend to see happen? And I’m sure there’s a variety, but kind of things that tend to happen in families that are going through this experience that we might not be so aware of that that could be getting in our way?

Amanda (10:55):

I think it’s true. You see a dichotomy between the families, especially if it’s a first child, the mom or dad is just there almost 24 hours a day almost to the point of ignoring their own needs. We have to ask, when was the last time you had a shower? When was the last time you had a meal? You can see someone like hoarding snacks at the bedside and trying to eat. I’m like, why don’t you take 30 minutes and just go into the lounge and just give sp yourself some space to breathe and focus on yourself. And then on the other side, you have parents that I think do fall into the category of avoidance who don’t visit very often. And I do want to say that as a NICU provider, we don’t come to the table thinking like, oh, you’re a bad parent if you don’t come.

(11:45):

I think most of the time we are aware that obviously the NICU can be a really triggering place. So if any parents of NICU babies are listening to reach out and talk about reasons why you may not be coming to the NICU and not assume that we’re judging you from the provider standpoint, because we do understand that it can be an overwhelming place. But I think talking to your nurse or social worker or psychologist can help you come up with a plan. We can let you know when is a good time to visit when you can be actively involved in changing their diaper and taking their temperature versus just standing at the bedside or staring at your phone for eight hours, not really getting involved. Cause I think keeping to yourself and not doing the hands on work promotes this sort of insular feeling of not being involved with your baby and feeling more like a bystander, which can be alienating and kind of want you to not visit feeling like you’re not involved in your baby’s care, so why should you even be there?

Dr. Stephanie (12:44):

Oh, that’s right. Interesting. Yeah, I think in addition to, so we talked about the sympathetic nervous system arousal, the avoidance around engaging in caregiving tasks. There’s a bunch of other things that show up that we see a lot in NICU parents, and one that comes to mind is a sense of preterm babies or preemies look really different from full term babies. They’re really small. They might have thin translucent skin, they also have wires attached to them on their foot tap to their face. So a lot of times we’ll hear parents talk about how they don’t feel like their baby is their own and they don’t really look like anyone. They might look strange or even alien. And we try to normalize and validate that that is an okay experience to feel and it can lead to feeling detached from your baby. So what we try to promote is, and I think the technical term is infant redefinition, but what that really means is sort of engaging in caregiving even with these feelings of detachment and uncertainty to promote the bond. Because what we often have said in our say in our course is love isn’t necessarily just a feeling, it’s an action. So the more that you can take control and power over your baby’s caregiving, the more that bond will slowly and gradually develop. And it’s okay if it does, it’s not felt right away. I think a lot of people can feel shame over that, but it’s something we see so often in NICU parents.

Amanda (14:48):

I think a lot of what we do is just identifying and saying out loud the feelings that I think people have but are afraid to say themselves, it’s okay to feel angry. It’s okay to feel guilty, it was your fault. It’s okay to feel jealous of people who have full term babies. It’s okay to feel grief that you’re not at home and the nursery that you set up and your glider recliner chair, but you’re in a hospital surrounded by other families and they use constant alarms. It’s okay to feel pissed off about that. And I think people don’t talk about that so they feel uncomfortable and ashamed to admit those feelings. But I think a lot of what we do is just to call it out and hopefully people resonate with one of those and feel that it’s a safe place.

Dr. Stephanie (15:34):

Great. Particularly in a environment where there’s so many, I mean Amanda can speak to this more because she’s more sort of steeped at the hospital setting, but there’s so many providers in the NICU that it’s such a common experience for parents to think, what is my role here? What is the point of me even being here? What can I provide that the nurses and the social workers and the physicians and the OTs and the physical therapists and the speech therapist, every sort of facet of the medical world is there present for their baby, what’s the point? And what we try to emphasize is that only a parent can provide warmth, affection, love, and care that a parent can provide. That is the essential role. And what we say is it’s its own form of medicine.

Amanda (16:27):

Right.

Dr. Sarah (16:29):

Oh, that’s so empowering because I think a lot of parents, I would imagine can feel like stripped of their role and of their power and agency as a parent, as a lot of the things you pictured yourself doing for your child are being done by someone else before your eyes and you feel so helpless to have the role you thought you’d have that to be reminded that those tasks are just tasks when they’re done by someone else. And the love that you would be in sharing with your child during those caregiving activities can be given in other way, can be given at other moments and it doesn’t have any less value.

Amanda (17:11):

And we always say absolutely to our families, and as a nurse say to our patients, like you as a parent are an important part of the care team in the NICU, just to give them a place at the table and not feel like a visitor to feel like they really belong there because you as the parent are the one looking at your baby for hours. Upon hours. You’ve taken a 5,000 photos of your baby. I’m sure when you go home, you’re looking at them. When you’re at the bedside, you’re really engaged in a way with your baby that the care team just isn’t. So we always encourage families to speak up to the care team if they feel like anything is off or wrong because as a physician or a nurse in the nicu, if a parent says that something is off, we really do listen and take heed of that.

(17:54):

So in our course, we encourage families to find their voice. And one thing particularly is to participate in rounds, which is the daily team meeting where all the people on your baby’s care team meet once a day. And that can be a really overwhelming thing for a family member to be a part of at first because it’s like 12 different people and everyone’s talking about your baby, not necessarily to you, but amongst themselves. And they’re using words that you’ve never heard and using kilograms instead of pounds and MLS instead of ounces and just all these abbreviations can sound so foreign. So we really give parents a step-by-step process to gear themselves up to get involved. And it starts with something just calling your nurse after rounds and asking what was talked about. Then maybe you go to rounds and just sit and listen and then maybe next time you come with one question prepared to get you to a point where you feel comfortable being a person at the table and you really are participating in rounds. And I think that’s a solid way for a parent to really feel like they are part of the care team.

Dr. Stephanie (19:02):

Yeah, empowered.

Amanda (19:04):

Yeah.

Dr. Sarah (19:06):

And I think that’s very intimidate, could feel very intimidating. So I think that’s really for sure, nice that you are providing people kind of like a template for it, like a crib sheet, Hey, this is it. One, it makes sense that this is intimidating. And also let me give you a quick peek behind the curtain so it doesn’t feel so intimidating when you actually do it because it’s not, I think for anything, when we know what’s happening and we can make sense of something, it doesn’t feel so scary, but when we have no idea, it can feel too big to enter into.

Amanda (19:41):

And we do our best to demystify all these things that happen in the NICU and kind of break it down for a normal person to digest and understand.

Dr. Stephanie (19:51):

Yeah. Because the uncertainty is also part of the sympathetic nervous system, arousal, just not knowing and how you fit in where you belong, what to do.

Dr. Sarah (20:04):

I’m curious too, obviously, I’m sure a big fear that a lot of parents have when they have a child in the NICU is that we’re not going to be able to form this bond, aren’t missing out on very valuable time to create a secure attachment. I get a lot of questions about attachment that are kind of, what’s the word, very anxious. And that’s regardless of NICU, right? Just, oh my gosh, does this mean this thing happen? Does it mean this? So a lot of catastrophic thinking around detachment. I think there’s a bit of a byproduct of how mainstream the conversation about attachment science has become, but in some way, and in a lot of ways that’s fantastic because it’s on more people’s radar. But in some ways there’s like, it’s a tricky balance because I think the more mainstream the conversation becomes, the more sort of telephone tag kind of happens where, oh, I’m losing actually the, I’m getting a little further away from the facts. And so I like to challenge some of the myths I think, or surrounding attachment. And I think this overlaps a lot with the NICU conversation because I think a lot of people think I can’t bond with my baby until they’re home with me. Or yeah, the clock, there’s a sense of urgency. The clock is ticking on my window to create the secure attachment. How do you help parents understand the bond and the attachment relationship when their child’s in the NICU?

Dr. Stephanie (21:41):

Yeah, I mean everything that you just said, I feel so much in my practice as a therapist who works with a lot of new moms and which actually makes me think about how I eventually think we should talk about life after the nicu. Yeah. Cause that’s important too. But I, what’s so important is being responsive, but being responsive and engaged, not perfectly, but from day one, bonding starts, and we say this in our course a lot bonding starts now isn’t no time, there’s no sense of urgency today, and it might not look the way that you thought it was going to look like. You might not be breastfeeding right now and you might actually not even be able to hold your baby right away.

(22:48):

But there are other ways that that can promote that bonding. And the sense that you are there, which is really what the baby or your child needs most, is to know that they’re held in mind that you’re going to show up for them, that you’re going to attune to their needs, not 100%, maybe not even 70 or 60% of the time. So we do talk about ways that if you can’t hold your baby or if you can’t feed in the way that you really want to or envisioned, there are other ways. Containing touch is something that we talk about, and that’s a huge NICU term, which is gently, but gently but firmly putting your hand on your baby to show that you’re there and it actually really can calm them in during pain, during distressing time, singing to your baby, talking to your baby. There’s something that we call, and I don’t know how widespread this is, but scent hearts where you sort of take a piece of fabric, you put it in your shirt or in your bra for a day and it captures your scent and then you leave it in the isot and it actually has been shown through research to reduce the NI NICU length of stay.

(24:15):

So these small gestures have huge benefits for your baby’s care and for the bond and attachment.

Dr. Sarah (24:28):

It’s interesting because that makes me think about the fact that there’s so many ways beyond touch that we are able to communicate to our child’s nervous system and their brain and their body that we’re there and can be a soothing presence. Even when we talk about, I talk about tantrums a lot, right? Talk about co-regulation and when our kids are totally melting down, losing it at a total 10 out of 10, and we are trying to name their feeling and validate their feeling, but it actually just makes ’em worse. And it’s, I’ll often say it’s like, well, how can you validate your child’s experience without words because the words are too stimulating in that moment. There’s so many different ways to get into a child’s inner world and offer something that is regulating to them that isn’t necessarily like touch or words or whatever. If one avenue isn’t accessible to us, what other avenues do we have? And so the pressure of a hand on the chest or a scent or a sound, like we can come into their brain from lots of different places. It doesn’t have to be touch.

Amanda (25:45):

That’s a good point because touch is often so limited both by your baby’s medical condition at the moment, but also the fact that you just can’t be in the NICU 24 hours a day. Even the parent that wants to be the best parent by whoever’s definition has to go home at some point because they have a job and they have a home and they probably may have other children or family members to attend to. So that’s just also hard to come to terms with that. You just can’t be there all the time,

Dr. Stephanie (26:17):

And it doesn’t mean you’re a bad parent. That’s just the reality.

Amanda (26:20):

Right? Yeah. And also obviously as a parent, one way that you bond with your baby is feeding them. And if maybe you wanted to exclusively breast or chest feed, that’s also probably not totally realistic in the NICU because you just can’t be there 24 hours a day, seven days a week, day in and day out. And also a lot of babies don’t start out eating by mouth in the NICU. Oftentimes they’re tube fed or IV fed. But we talk about ways to still get that bonding experience by holding your baby, doing skin to skin or kangaroo care while they’re getting fed by the feeding tube. And you can still experience that with them during their feeding time or offering them a pacifier as they’re getting a tube feed. And then eventually we cross a path into bottle feeding and how to hold a smaller baby while offering a bottle and ways to burp them and how it’s different than holding your niece or nephew who was born at 10 pounds at birth. There’s different ways to do that. So we talk about that and have a little section where Stephanie and I have a little preemie baby doll and demonstrate how to do that. Because it takes some skill. It’s easy once you get it down, and I would say almost every parent is able to do it, but it’s need something to show you.

Dr. Stephanie (27:40):

And it can be intimidating because the baby is, preemies are small and they often can be seen by parents as fragile. They are a little fragile. I mean, they’re strong emotionally because they’re getting through something so extremely stressful, but they’re little, which can be alarming.

Dr. Sarah (28:03):

Yeah, it’s interesting. Yeah, it makes me think too about our ability to see our child as strong, and that’s exceptionally difficult in a NICU when they physically look fragile. And I imagine that’s a hurdle that some parents may struggle to get over, is to really sort of show up and embody this real authentic confidence that my kid can handle this. We can handle this. Doesn’t mean it’s not excruciatingly hard, but that inherently I believe, and I trust that I myself, the parent and also my child and our family, we can do this. And sometimes you have to fake it till you make it. But I imagine that remembering to kind of embody that confidence, there’s a lot of benefit to that. We see that in other areas of parenting as well. I do a lot of work with parents of kids who have severe anxiety and in the moment it does not feel like they can survive that feeling of anxiety.

(29:09):

And they’ll do absolutely anything to get out of that feeling, including pulling us in to rescue them from it. But when we really believe, oh, this is a really tough feeling and I know that you can handle it, that kind of embodying that confidence really helps bridge the child through and out of the feeling eventually. And I think in a way, this NICU experience is similar. I’m imagining because it’s like I have to believe and sort of show up in a way that shows my child in all these ways that are beyond language. This is obviously super preverbal. This is just nervous system to nervous system talking, but that I believe that you can do this and that you are strong and that we are strong, and that’s how you get through some. That’s how you kind of bridge out of some of these really tough moments and not have to go back to that attachment, that fear, if I’m running out of time to make this a secure attachment, I to believe that we have time, we have time, and we’re doing the work that we need to do now so that we can keep going once you get out of the hospital.

Amanda (30:25):

And I think having it forming a secure attachment, although you said it’s so in popular culture and media right now, that word, that phrase, but it’s also very nebulous to someone who’s not a therapist. I know the idea of secure attachment, but it’s hard to really define. So I think that’s why it’s helpful when we offer these tangible tips. What can you do today in the NICU on day zero? What can you do on day five? What can you do once you feel confident to do these sorts of things? Because it gives you a roadmap. You don’t have to worry about getting to the end point of secure attachment. You can just worry about, let’s just change a diaper today. Let’s just take a temperature today. Let’s just listen to rounds today. And then over time you can reflect and look back and be like, wow, this is week three and week zero.

(31:12):

I was a preemie as a parent. I didn’t know what was going on. And then you can see yourself, how you’ve grown as a parent and hopefully that experience looking back of what you couldn’t do before, what you can do now will show you that you do have the confidence even if you don’t feel like it. That makes me think of our next tool that we offer is our baby diary, which is great because it’s a physical template that you can print out or use as a template and have a note on your phone. But we guide families in terms of what they can do for the baby, and it gives them a place to write down everything that they’ve done so that they can look back and see all the progress they’ve made. As a parent, Stephanie, I know you kind of in graduate school worked with the baby diary originally.

Dr. Stephanie (32:07):

Yeah. I think it’s really designed to Sarah, what you to emphasize or strengthen that belief that I can do this. Because the more that you actually do and then reflect on what you’ve done, the more you can believe that you’re doing it right. You’re giving care to your baby, you’re engaging in support, you’re showing up. And so I think the reflection a NICU parent is so essential because you can, NICU parents can so easily get caught up in what’s not happening. My baby hasn’t gone a day without a dsat, or my baby’s still not five pounds, or my baby’s still not feeding from a bottle. But the more that, to emphasize your point, the more that we get caught up in what they can’t do and feel defeated and anxious and sad, I mean those feelings make sense. But the more we do that, I oftentimes I had imagine the more you show up to your baby’s care in this sort of defeated deflated state. And I think what you were suggesting is a kind of way to foster post-traumatic growth. I think what you were saying was really from the framework of post-traumatic growth, this is a traumatic experience and the more that you can really believe that you’re going to make it through and do the things that are in line with that belief, the more the bond can form. But also the chances for just tremendous growth for you as a parent and your baby and resilience.

Dr. Sarah (34:05):

And I think Amanda sort of you’re saying, okay, secure attachment, that’s so abstract and what does that even mean? And a lot of times, a lot of the stuff when you’re dealing with a brand new baby, especially in the NICU, and everything can feel kind of big and impossible, and I don’t even really understand it. So we get stuck in that space. We kind of get paralyzed. We don’t really, we just kind of freeze. And so I think what you guys are doing in this, just in general, this idea of being like, okay, I got to put one foot in front of the other and I just have to focus on what I’m doing right now. What can I do today? What can I do in this moment that actually helps people to, if you just keep doing that, you’re going to look over your shoulder and be like, whoa, I’ve come a real long way.

Amanda (35:03):

That’s a work of the secure attachment rather than just focusing on the end goal.

Dr. Stephanie (35:07):

Yeah. Cause then you miss the process too, and the process is the joy, the whole thing.

Dr. Sarah (35:18):

Even if it’s really, really crappy because it’s the process of being a NICU parent, is it probably excruciating, but there’s still opportunities and moments for joy and growth and connection and there it’s all in there together.

Amanda (35:43):

Right?

Dr. Sarah (35:44):

You have be able to see it.

Amanda (35:45):

Right and we offer prompts too in this diary to be like, what does my baby look like? Who does it look like? Ways to maybe get out of the medical mindset that the NICU was so focused on, it’s like how much weight did he gain? What were his vital signs? But to really enjoy the softer side of parenthood that is so often overlooked when your child is sick, let’s say, who does your baby look like? What are your hopes and dreams for your baby baby? When did your baby first smile at you? When did they first take a pacifier? And those prompts also I think, help ground parents because it’s a list and you just fill it out. If your mind is all over the place and you yourself can’t come up with these sorts of milestones for your baby, we give ’em to you. And then we have places where you can fill in your own stuff too. But I think it’s helpful just to take that mental load off yourself and just print this thing out and follow our prompts. And that’s part of the work too.

Dr. Stephanie (36:44):

It’s palatable and digestible and when it’s everything can feel so overwhelming.

Dr. Sarah (36:55):

So let’s talk about when you get home life after the NICU, because I think that’s a huge, like…

Dr. Stephanie (37:02):

I think that gets missed a lot. What I’m realizing in looking at all the resources out there, there’s gaps, but I think a real big gap is life after the NICU. It’s like they’re home. We’re sort of done now. And what I think we don’t often talk about is basically what’s in a lot of the literature on having a medically fragile or sick child is this idea that even when your baby is now medically stable and healthy, parents might continue to see their baby as fragile and unstable and operate and behave as a parent from that framework. So what we often see with parents is there might be a excessive concern, high frequency use of healthcare difficulties, separating difficulties, or even just a refusal to set age appropriate limits and allow exploration, which is so important with a developing baby and what we call, there’s a term for this, it’s called vulnerable child syndrome.

(38:27):

And what we talk about is being able to balance this idea, it’s okay to protect your baby, it’s okay to want to, for them to feel safe and be safe, but also can you as a parent, allow for that exploration so that they can go off on their own and you’re there, you’re always going to be there, but they don’t, they might not need you in the way that they did when they were in the NICU, particularly if they’re developing and growing and they’re too now and they want to play in the yard without you. If you keep following because you’re afraid and sort of operating as though they’re fragile and sick, you might be right by their side hovering over them, making sure that they’re not getting into too much dirt and then can lead to a more anxious attachment style. And then lack of desire to explore in the child. So that’s something that we aim to talk about a lot because we feel like it’s a little missed.

Dr. Sarah (39:41):

Yeah, I mean, that makes me think a lot about the idea of a secure base when attachment there. We talk a lot about a parent being a secure base, which means that we, not only do we meet our child’s needs enough of the time that they believe that we will, so they can kind of rest comfortably in their trust, in our ability to take care of them. Which again, for the record is not all the time, no more often than not, I say like 51% of the time we meet our kids needs, they will probably assume we’ll be able to, but it doesn’t just stop there. It also is our ability in meeting their needs enough of the time that they can trust us to be there. What that then does is allow them confidence to separate from us and explore their world because they know and believe we’ll be there when they come back.

(40:35):

And sometimes as parents, we can interrupt that exploration process because we’re too anxious and so exactly. We need to meet their needs enough of the time that they trust that we’ll be there when they leave and come back. And the leaving and coming back is a really important part. We have to let them go and explore and take risks and see how far away from us they can go before, oh, I need some fill up. I have to go back to my secure base and refuel. And then we’re there for them, but we can’t follow them around otherwise we’re not being that secure base. Right. Secure base doesn’t move that much.

Dr. Stephanie (41:16):

Yeah, exactly. And if you’re starting out in your child’s life, if your child’s born into the world and they’re sick or they’re not, they’re born preterm, that it would make sense. I just want to validate it would absolutely make sense that a parent would continue on and maybe be a little more restrictive in terms of allowing that exploration. And we want to emphasize that that is, it’s really, really important. And so we sort of challenge parents to think about what limit can you set today or what can you encourage an age appropriate developmental milestone? Can you encourage that maybe you’re really anxious about? And can you encourage it and feel anxious about it?

Dr. Sarah (42:10):

Yeah. Can we tolerate our anxiety as the parent enough to let something happen? That’s scary.

Dr. Stephanie (42:19):

Exactly.

Dr. Sarah (42:20):

And in doing that, we’re showing our kids like, Hey, feeling anxious is safe.

Amanda (42:30):

And our goal is to capture families while they’re in the NICU. And to not warn them, but just to educate them about this being a risk factor for having a traumatic early life experience of having your baby in the nicu. You may be at risk of developing vulnerable child syndrome and how can you take those steps to avoid that?

Dr. Stephanie (42:55):

Yeah. And we see that happening with other risk factors or when parents experience fertility challenges or pregnancy or delivery complications. And then of course, like PMADs, perinatal mood and anxiety disorders.

Dr. Sarah (43:15):

That makes a lot of sense. So if people are listening to this and they want to, a lot of times I’ll say, I work with a lot of parents who are expecting, or they don’t know that they’re going to have what’s going, whether it’s you don’t know you’re going to get a postpartum depression, you know, don’t know if you’re going to have a traumatic birth experience. You don’t know if you’re going to have a NICU stay. And obviously we hope that everything is smooth sailing, and I think it’s important that we believe that things will go well. We don’t white knuckle it through pregnancy either. But I think one of the things I’ll often encourage parents to do is just you make a birth plan, make a postpartum mental health plan. What would you want, want care to look like? If this occurs? How would you want, who can you think of a couple people who you would want to reach out to if you need support, can you just plan ahead in that way?

(44:20):

Do you need postpartum care? Do you want to set up a postpartum doula or a baby nurse or some way to support your mental health in the recovery, the postpartum? And I think thinking about a NICU possibility and thinking about how would I cope with this? What would my supports be if I have other kids who’s going to help out with that? It’s like an insurance policy. You never want to have to use it, but it’s good that it’s there and it can really help if you do find yourself in that situation. Are there things you encourage parents to think about who maybe are listening to this, they’re pregnant, they have no expectation that they’re going to be in the nicu, or maybe they do because they know that that’s there’s been a diagnosis in while pregnant and they can anticipate it in advance. But for people who are pregnant right now, either because they’re listening because they’re curious or they know there’s going to be a NICU stay, or maybe they’ve just been in the NICU and they’ve done it before and they know they need to think about it, what would you advise those parents to be thinking about in advance?

Amanda (45:28):

Obviously that our resource, NICU Nook, is available to families. And our true goal is really to capture families on day one because I think the earlier that you acknowledge that you would like some extra guidance and support, the easier your time is going to be. Rather than to be suffering alone or to not know, or just to be lost in the bowels of the internet, reading all sorts of different resources. I think just to have one consolidated source of information is helpful to avoid getting lost online and just that you’re not alone. And even though in the NICU you there, you can always see the other babies and the other families, but to just to know that there is help available to talk to your neighbors, to reach out to friends even who’ve not had NICU babies, and to make contacts in the NICU with other families that are going through it with you and just to be open about what you’re feeling. And I think the sooner you acknowledge to yourself what’s going on, the easier it is for you to get help. Because if you just go on and persevere and act like everything is fine, then you’re missing out on that time to kind of recover yourself.

Dr. Stephanie (46:50):

I think to expand on that really important thing that we often will, we often see parents blame themselves. So just to remember, this is not your fault. There is nothing. If you could have prevented this, you would’ve prevented this. So it’s not your fault. And I think that’s just such an important thing going into something like this. Cause it’s so shocking and can be so just surprising and traumatic and confusing and scary and just every emotion that you could possibly feel, NICU parents feel right away. So it’s not your fault. And then I also think, which Amanda and I talk about in our course is being specific. You’re going to need help from a friend. You just are. And that’s okay. Even if you didn’t have a baby in the nicu, you as a new parent with a baby that you take home that’s full term, you need help. It takes a village. So I think it’s really important when you are asking for help from friends, just to be specific about what you need. I need you to watch my kids today. I need you to help me cook dinner. Because oftentimes friends don’t know exactly what to do, and that makes sense. If they don’t know what your experience is, they don’t know what you need. And the more specific that you can really be it, the more empowering it will feel to sort of be able to voice what you need in the NICU too with your baby to your care team and the better you’ll feel.

Dr. Sarah (48:42):

Yeah, I think that’s such good advice. No matter what happens, I think get, no matter what happens postpartum, you need to, you’re going to need help. And so thinking in advance of what that help looks like for you, even just imagining what you might need, and then obviously once you’re in it, you pivot, you iterate, you figure out what a really you need. But that idea that I can ask for specifically what I need, and I trust that the people who want to help me will in those ways, and I’m allowed to just be real specific.

Amanda (49:15):

And I think friends also appreciate the directness as well, and family members too, because it feels kind of awkward to be like, well, let me know if you need anything. And the conversation just dies off from there. I know personally, I would appreciate if someone said, Hey, can you go pick this up? Or can you go to target for me and get that? So I think it’s mutually beneficial to be direct about what you want if it allows the people in your life who want to help to you in a meaningful way.

Dr. Sarah (49:42):

Yeah, I totally agree. I’m like, tell me what to do because I have all this to give, but I need direction. You know what I mean? And I think most family members and friends would do anything for you in those moments, but I think we’re so afraid to just say or overwhelmed. So again, thinking in advance of what would I need?

Dr. Stephanie (50:05):

I think especially with, and this might be a generalization, but just in my anecdotal experience, I think women are caregivers. So women often have a lot of, might have difficulty asking for care to be given to them and asking for help, but it’s so important, especially in this experience.

Dr. Sarah (50:27):

Yes. So if people want to learn more about you guys, your course, if they want to find out how to work with you guys, where should we direct them?

Dr. Stephanie (50:39):

You can visit our website. It’s www.nicunook.com. That’s N I C U N O O k dot com. But also, we’re available for any questions that people have about us, our course, and they can email us directly at hello@nicunook.com.

Dr. Sarah (51:03):

Great. Okay. We’ll put that in the show notes because it’s really helpful and I’m so glad you guys are doing this because it really does fill a need that I know a lot of parents feel very alone in trying to navigate.

Dr. Stephanie (51:20):

Right. Thank you. Yeah, absolutely. There’s such a gap. We just saw a gap and we really wanted to fill it together.

Dr. Sarah (51:28):

That’s cool. You get to do it together because you’re friends and that’s awesome.

Dr. Stephanie (51:31):

Yeah.

Dr. Sarah (51:33):

All right. Well, thank you for coming on the show.

Dr. Stephanie (51:36):

Oh, it is our pleasure.

Dr. Sarah (51:44):

Whether it’s a NICU stay or a perinatal mood and anxiety disorder, like postpartum depression or anxiety, it’s crucial for expecting parents to prepare for the what ifs ahead of time so they have a plan in place. And that’s exactly why I created a mental health postpartum checklist and made it completely free because I want all new and expecting parents to have access to it. This interactive checklist and workbook will walk you through everything you need for establishing your personalized, physical, and emotional support systems throughout your postpartum. You can feel more confident and relaxed knowing you have all your ducks in a row and have a game plan for whatever your new little duckling brings.

(52:21):To download my mental health postpartum checklist, go to my website, drsarahbren.com and click the resources tab. That’s drsarahbren.com/resources. Thanks for listening, and don’t be a stranger.

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