Returning to Work After Having a NICU Baby

Two babies, one breathing and one not. That was my introduction to motherhood. I remember the neonatologist saying that one baby was doing ok and that no one was sure if the other one would survive. At that moment I felt utterly helpless as I was (and am) a trained neonatal nurse practitioner who had taken care of hundreds of critically ill infants at that point in my career. I used my training to provide life-saving care to newborns for over ten years by the time we were expecting our twin boys. I learned to speak gently and softly to families in the midst of crisis. When my babies needed life-saving interventions due to their prematurity there was no “me” to lean on. There were only lights and sounds and pain and emptiness and lying in a bed alone and without my babies for the first time in 30 weeks. It was overwhelming to experience a preterm delivery and not be able to intervene in any way. The mother experience was new and it did not feel right that my babies were struggling in a separate part of the hospital without me.

And then I remembered my dad’s words, words I heard my entire life. “Think straight to prevent panic.” As my dad was an Air Force veteran and highly trained pilot, I heard his words nearly every time I encountered overwhelming circumstances; either personally or professionally. Now was the time for me to “think straight to prevent panic” and find the resources I needed to be the mom I wanted to be. I learned that thinking straight could sometimes only happen after breaking down, after spending the morning crying while pumping or crying when I saw a mom walking with her sweet, chubby and healthy baby in the neighborhood. I learned that the breakdown was a “normal” part of the process that had to occur so I could feel the rage, sadness, guilt that were the “gifts” of the experience of having a medically fragile baby, times two. In order to move on, it was necessary to accept my new reality of premature babies and NICU life and the never-ending feeling that the proverbial “other shoe” was going to drop at any moment. I had to feel the joy of being a mom, regardless of the smallness of the package in which it was delivered. It became important to celebrate our boys’ small wins with my husband so he too could share in joy of parenthood without the constant stress of critical illness. While frequently reliving the negative aspects of having two premature babies, I was forgetting to incorporate the happiness that the babies brought into our lives. I discovered that if we the pain and trauma from the extended hospitalization, we were also able to let in gratitude.

I desperately needed to find a mental framework that would allow me to process the trauma and find a way to incorporate all of the negative aspects of premature delivery and channel the energy into something meaningful. As it so happened, the channeling of this energy came about during my return to work as a neonatal nurse practitioner in the NICU. I HAD to feel all of the feelings to return to a job that I loved (and needed). It became important to mentally and emotionally process what happened in order to better connect with the families I worked with every day as I was not the same nurse practitioner after the boys’ delivery. I also carried the “gifts” presented to a NICU parent. These new gifts include the ability to navigate new territory, developing greater interpersonal communication skills, effectively sourcing educational material, fearlessly reaching out to new contacts and enhanced time management abilities. I developed a passion for helping new families navigate the NICU experience as well as helping to visualize what life looks like in the home environment with a new baby who happened to spend time healing and growing in the neonatal intensive care unit.

Parenthood is often a scale weighing the difference between joy and hardship. The thing that often tips the scale is each individual’s ability to deal with the “trauma” of parenting.

When talking with a group of parents, there are often a wide variety of feeling around “the joys of parenting.” While there is a great deal of happiness that accompanies new parenthood, there is often some amount of distress, especially when discussing the newborn to young infant stage. While some families seem to be “blessed” with babies that sleep through the night early, feed like a champ and only cry for diaper changes and when they are hungry, the other 99.9% of parents feel a certain amount of distress after reflecting on the newborn experience. The notion of trauma is widely understood as something that upends an individual’s system of belief and leaves a feeling of uncertainty surrounding decision and is packaged by the term post-traumatic stress. Many first-time parents experience a loss of self and lack of control now that a very small little person occupies every ounce of space in their brain and their heart. These experiences, coupled with hormones and sleeplessness can sometimes be classified as a trauma. When you add in the experience of being a parent to a NICU baby the scale between joy and distress often tips toward the side of distress. While most mothers rise to the unique challenges of parenting a NICU baby it often not without some degree of fear. This fear, coupled with anxiety, concerns about the future and the lack of control often set the stage for some degree of post-traumatic stress.

The idea that the pain and messiness of trauma can be improved when individuals are able to take stock of their own resilience and learn from their experiences is referred to as post-traumatic growth. Personal and relational post-traumatic growth can occur when one attempts to understand the bad AND the good that can happen after traumatic experiences.

If you are reading this and are a NICU mom and you are returning to work, hear this first;

AFTER THE NICU, YOU WILL HAVE DEVELOPED AN ENTIRELY NEW SET OF SKILLS THAT WILL ENHANCE YOUR PERFORMANCE AS AN EMPLOYEE.

While confidence in navigating everything motherhood may be a work in progress, your ability to manage work after a baby is only enhanced because of your NICU experience.

REFRAMING THE POSTPARTUM EXPERIENCE AFTER THE NICU

1. Honor your body and all that it has done for you and your baby, no matter the length of time it housed you baby.
2. Actively and frequently check-in with your OB/postpartum medical providers in order to best understand the changes your body has undergone in the postpartum timeframe. It is important to fully understand the difference between what is normal and what should be evaluated by a medical provider.
3. It is normal to experience a wide range of emotions after delivery. Many NICU families encounter a heightened degree of stress related to the level of care and intervention their baby required while hospitalized. The time after NICU discharge is joyful, but is also often accompanied with feelings of isolation, fear and apprehension about the future. It is important to be able to identify your feelings, name them to “tame” them in order to distance yourself from the emotion and be able to move out of any the overly emotional state. Side note, sometimes this requires the help of a mental health clinician.

THINGS TO CONSIDER PRIOR TO RETURN TO WORK

1. Decide to recognize the “unfairness” in the situation. The absence of federally mandated paid maternity leave and the minimal provision of job preservation allowed under the Family Medical Leave Act (FMLA) are inadequate when compared to the known benefits that flexible and extended parental leave provides. The reality is that many babies requiring NICU care are hospitalized for weeks to months after their delivery date and under the current system an employee’s job is only guaranteed for up to 12 weeks in total. The lack of control over these systemic issues can seem overwhelming. It is pertinent to take inventory of your personal needs as well those of your baby and your family prior to making the decision to return to work. Some mothers find the NICU to be a time of particular difficulty as hospitalization often leaves the mom questioning her role as the baby is not in her care at all times. Research indicates that fathers often feel a significant amount of distance from their peers with children, which can sometimes lead to depressive symptoms.
2. While the rates of postpartum distress, depression and anxiety are higher in families with a NICU baby, there is some data to suggest that women who experience a preterm delivery report higher levels of personal growth several years after their NICU experience. Return to work may aid in stabilizing a new mother’s sense of control if they are returning to a role that they performed well in prior to the birth of their infant. While returning to work may be a difficult task, it is important for new mothers and fathers to recognize the value work has provided and refocus some energy on that success prior to returning to work.

HOW TO SUCCEED AT WORK AFTER THE NICU

1. Develop a growth mindset in relation to your view on parenting and parenthood. I think of the saying “there are plenty of perfect parents, they just don’t have kids” as a reminder that no one person or family is doing everything right all of the times. The idea that everything is either a “win” or a “learn” gives merit to the idea that while not everything goes as expected; those who learn often fare far better, as there is no “winning” in parenthood.
2. Own the trauma that you went through as a NICU parent. Develop a mantra that serves as a reminder of how strong you are because of your experiences. This idea gives birth to resilience and provides a mechanism to internally build on during and after challenging events.
3. Communicate with your employer early on during your maternity leave and discuss the challenges that you foresee when it is time to return to work.
   1. Some companies may have extended benefits for families who experience the NICU, or you may have the opportunity to ask for an extended maternity leave if your baby remains in the NICU after your projected return to work date.
   2. Consider easing back into your position by starting work at the end of one week in order to have the weekend to make changes based on 2-3 days of work. Consider saving or banking a few days of leave and work a few weeks with a reduced schedule in order to ease into the changes in your schedule.
   3. Some women choose to return to work while their baby remains hospitalized in order to preserve maternity leave in order to be home when their baby is discharged from the hospital. This is one option to consider if you have a job that is either inflexible with extended leave options or your employer allows you to work remotely with an asynchronous schedule. If your work tasks are able to be divided around your time spent caring for and bonding with your baby this may be a viable alternative that is available to you.
   4. If your direct boss is not able to provide greater clarity on what a leave extension would mean for your position at work, the next step would be to discuss all options with the human resources department or whoever oversees benefits for your company. This department should be able to tell you the degree of flexibility that is offered through your employer as well as the legal obligation of the employer.
4. Explore potential changes to your work schedule in order to meet the needs of your baby, yourself and your employer.
   1. Post-pandemic, most employers have reimagined the geographic location of their workforce and this may mean that there are remote work options. Even if working remotely is not a permanent change, the ability to work from home even for a few weeks may benefit you and your baby.
5. Devote some time into figuring out the logistics of continued pumping with your return to work. This may include discussing the space and time that you need with your employer prior to your return in addition to identifying a mom mentor who successfully navigated pumping at work.
   1. It is important to first understand that under most employment circumstances your right to pump and the space necessary to do so is protected by federal law. Check out your state’s breastfeeding workplace laws here.
   2. Per the FLSA law, Employers are required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. Interested in a Work & Mother Suite for your building? Send us a request here!
   3. Know that the conversation surrounding pumping and storage of breastmilk is ongoing. The length of time a woman decides to breastfeed or pump is based on the individual needs of each infant and mother pair. A one-size fits all approach is not the solution to pumping expectations at work.
   4. Encourage your employer to address these issues in a manner that clearly delineates the time that you have available to pump and how your work will be covered during pumping sessions.
   5. Help support The PUMP Act! The Break Time for Nursing Mothers law, passed in 2010, provided critical protections to ensure that employees have reasonable break time and a private place to pump during the work day. However, nearly one in four women of childbearing age are excluded from coverage and have no clear right to break time and space. It’s time to close the gap. Use this easy action tool to urge your members of Congress to take action!

NICU parents often want to put their hospital experience behind them, but the alternative to dismissing the experience is to embrace the feelings, recognize the trauma and identify at least one way in which personal growth was accomplished. It is imperative to use our NICU skill acumen to advocate for ourselves and our babies, in the workplace and in any place where our needs or our infants’ and families’ needs go unmet. This newly found voice serves not only as a mechanism to protect your baby, but it also serves as proof of personal growth. Parenthood often simply involves putting one foot in front of the other and making the next best choice. The secret is to leverage the unique set of obstacles that your family has overcome, recognize your own strengths and weaknesses, reach out for help with the road seems uncertain and celebrate the micro wins that parenting in the early years requires.