- What feelings and concerns will Sunita and Mukesh have on Sunita’s initial admission to labour ward? What is the role of the neonatal unit team in supporting the parents at this time?
Sunita and Mukesh will experience a range of feelings and emotions from shock, disbelief, fear, anger, loss and concern to name a few. They may be bewildered as the events unfolding in front them will be outside their experience. Although the children are with the paternal grandparents, they may be concerned about the children’s understanding of events and unplanned separation and change to the children’s routine. Sunita, if working would not have commenced her maternity leave and Dad may be anxious because he has no sense of how plans will unfold and how much time he will need off work.
It is important that the neonatal team introduce the parents and try to give them a perspective on the event, discuss parental wishes and concerns. Good communication is paramount, ensuring that the language spoken avoids jargon, clear and concise. Parents may find it difficult to take on board the information, so giving the family time to digest is important. Introductions of who is who is important to commence the development of therapeutic relationships.
- Sunita is admitted to the antenatal ward. What impact may this ongoing hospitalisation have on the family? What is the role of the neonatal team at this time?
Child care may be a key concern. As the children are of different ages they will have different needs. Sunita may be anxious to be separated from the children and anxious if working of having finished sooner than planned. Mukesh will be trying to cover all bases – be supportive of Sunita in hospital, cover child care, communicate with extended family and juggle work.
The neonatal unit again continues to support the family. Key neonatal team members (both medical and nursing) should visit mother/parents on the antenatal ward to continue to update them on issues and discuss parental wishes. Sharing of written literature may further enhance Sunita’s and Mukesh’s understanding of events, options and the neonatal unit. If Sunita is able to, she can accompany Mukesh to the neonatal unit for a tour and meet staff. Parents often find being prepared for the environment helpful to both their understanding and their ability to cope. The neonatal nurse could discuss with Sunita her choice of feeding and provide her with information regarding the benefits of breastfeeding and expressing breast milk.
- Sunita re-commences labour and delivers. What initial care should be provided by the neonatal team to stabilise Shemi in light of her potential problems (see Table 31.1 in textbook chapter to review the problems and care issues for the preterm infant).
Stabilisation of Shemi. Follow ABCDE or keep baby, warm, pink and sweet.
Identify the neonatal support that should be given to Sunita and Mukesh during labour, delivery and stabilisation.
On arrival to Sunita’s labour room, staff should introduce themselves and plan of care be briefly discussed (Sunita is in labour and stressed and therefore needs clear and direct information). Once resuscitated and stabilised Shemi should be shown to Sunita and Mukesh before she is placed in the transport incubator and taken to the unit. An update of her condition and immediate plan of care should be shared with the parents. Mukesh may wish to stay with Sunita or go with Shemi to the Neonatal Unit. Parents should be congratulated on the birth of their daughter.
- One hour after delivery, Sunita and Mukesh visit Shemi on the Unit for the first time. The transport team is due to arrive in 15 minutes. How is the family supported during this visit and prepared for Shemi’s transfer to the network NICU?
Sunita and Mukesh should be welcomed to the unit. Hand hygiene is essential to prevent infection and therefore the parents should be shown how to correctly wash their hands before visiting Shemi. At the incubator the parents should receive explanations, using appropriate language of what they see – to include Shemi, ventilation, monitoring, infusions, etc. If Shemi is stable, then Sunita and Mukesh should be encouraged to touch and speak to their daughter. Handling should be appropriate to the condition of the baby and confidence of the parents. Sunita and Mukesh should be informed of the impending transfer and be given information about the NICU that Shemi will be transferred to. Arrangements if convenient for the parents/family could be made if a maternity bed is available for the mother to transfer to join the baby at the NICU. Parents may have religious wishes that they want considered e.g. baptism, blessing, etc. before Shemi is transferred. When the transport team arrive introductions with the parents should be made and an update should be given to the parents before the team depart with Shemi. Parents need to be given details on how to ring the NICU for future updates, location and visiting hours.
