Nov 4     34 min read

Occupational Therapist Who Works in NICU with Premature Babies

Updated: Dec 1

In this podcast, Dawn, an Occupational Therapist, discusses her experiences working in the Neonatal Intensive Care Unit (NICU). The NICU is a specialty area of the hospital that specifically cares for newborn babies that have medical complications.  These complications can be born prematurely, experienced a traumatic birth, heart complications, etc.

Host Speaker  0:35 

Thank you for joining us for another episode of I am Able. The goal of our podcast is to bring acceptance and awareness to our communities when working with educating and living with people of all abilities.

Jamie:  0:47 

Good morning, everyone. I am Jamie Lord Tovar. And today I’m going to be talking with Dawn, we’re going to be talking about in ICUs. Welcome, Dawn, how are you?

Dawn:  1:00 

I’m good. Thank you, Jamie. How are you?

Jamie:  1:03 

I’m pretty good. I’m pretty good as well. Thanks. So, um, Don, you’re an occupational therapist, correct? Yes. Okay. And so you have some, some experience in in ICUs. Okay, so, um, for those of us who aren’t real familiar with that term, can you go ahead and explain what an NICU is?

Dawn:  1:31 

Yes, well, NICU is an acronym for neonatal intensive care unit. So it a neonatal intensive care unit is a specialty area of a hospital that specifically cares for newborn babies that have medical complications. And that may be from being born prematurely, to having a traumatic birth, cardiac issues, some type of congenital defect that that causes them not to be able to go home right after being born.

Jamie:  2:14 

Okay. Oh, wow. So, so those would all be considered traumatic births, that the examples you gave us know are required?

Dawn:   2:25 

Few? Yes, you can use a lot of, well, if you’re born premature, it doesn’t. It’s not always because of a traumatic reason. Sometimes, no mom has been on bed rest, because she’s been having contractions and they’re not able to stop. And they know, they kind of know the baby’s coming. So it’s not necessarily dramatic. Or pretty woman could get rear ended at a stop sign and go into labor. And that might be a little bit more dramatic for her and for the baby, especially depending on where the delivery occurs. But sometimes when babies are born, things just don’t go well. Babies get stuck. Baby start physiologically not tolerating being born. And so you have like your emergency C sections, and you have babies who just are not able to breathe well on their own, their heart rate isn’t able to continue functioning, their heart attack, their hearts are able to continue functioning the way the way it should, and they need immediate specialized care. So not not all babies who end up in the NICU are are aware that that’s going to be that is going to be happening.

Jamie:  3:37 

Okay, okay. All right. So, so what are the most common reasons for that you’ve seen? So you’ve been you’ve been working it with the NICU unit for for a few years? Correct?

Dawn:  3:53 

Yes. I’ve been part time working in a local hospital at their NICU for 22 years. And recently, I have a kind of decrease my hours and I’m Per Diem. So I mostly work. Summers, and two Saturdays a month.

Jamie:  4:11 

Oh, wow. Okay. Okay. So so how is how is the NICU unit different from like a typical nursery?

Dawn:  4:21 

Okay, well, so this is a little complicated, more and more, so anyone would think so you there are actually four levels of newborn care that require some type of medical intervention. So you have a level one nursery, it’s can be called a well, a well, newborn nursery, basic newborn care, but it’s for it’s the kind of nursery that everyone expects their their babies to go to when when they’re born. These are for babies that are born full term and who are stable so they can breathe on their own, they can maintain their own body temperature there There’s no problems with cardiac or neurological stability. So there’s no problems with our hearts, there’s no, there’s no problems like with seizures, you can go to a newborn nursery if you’re born at around 35 weeks to, you know, to 37 weeks, which is considered to be preterm, but only if you you meet that level of medical stability, maintaining your temperature, you’re eating by mouth, okay? You don’t need any medical intervention. Sometimes a baby will be born and the assumption is the baby’s fine. But maybe their Apgar scores were a little lower than than the doctor would like. And they’ll they’ll observe the baby in a wellbore nursery for a couple of hours, and then maybe just to make sure they’re staying stable, and they can and everything’s okay, or make that assessment that the baby needs to be transferred. So it’s usually the only time that a baby that’s not quite stable is in a new one nurseries when they’re observing and trying to decide, can you know, is this baby recovering from being born? Or are we still having medical issues that need further workup? There is a level two or something called a special care nursery. Sometimes it’s called advanced newborn care. So these babies are going to have some health problems, but they’re not considered to be serious. So you can have a baby in a special care nursery that’s born after 32 weeks. But they usually don’t need support with breathing. And they’re not. And they’re not super small. So they’re going to weigh more than like 1500 grams, which is about three or four pounds. Sometimes babies, like if a baby’s born and they have a high bilirubin, you know, those orangey babies that they need to go into the blue lights. Sometimes they’ll send the babies home with a blue light blanket and the parents will treat him at home. But if they need to come to the hospital and be treated with the blue phototherapy, sometimes they’ll go to the special care nursery. If a baby goes home and runs a fever after like a day or two of being home, they might end up with a special care nursery. There’s nothing severe happening with a baby but but there’s still stuff going on that needs to be medically monitored.

Jamie:  7:29 

Okay, so mom and dad or parents needed just a little bit of extra help, just in case something were to go wrong with with those guys. But they’re, they’re pretty stable. It’s just, it’s more just to be safe.

Dawn:  7:44 

It’s not? Yes, basically, typical for a newborn baby to have a fever, for example. So okay, sometimes if labor has been drawn out, if there’s been a use of medications or procedures to kind of like move the delivery along, sometimes the baby will run a fever. And doctors will want to keep an eye on that fever to make sure that it’s not something significant. And so they want to monitor that baby in the hospital, not not at home. If a baby is born, and we’re not sure maybe maybe the nurse saw seizure, you know what they’re going to need to monitor that baby before sending them home. So it’s kind of a Yeah, I guess it’s just more it’s more of just, it’s a it’s for care for for babies that that they’re not ready to leave. But they’re not ready to say like, no, they need they need more specialized.

Jamie:  8:35 

Okay, so it’s like you’re not you’re not completely healthy, but you’re not completely sick, either. You’re kind of you’re in the middle.

Dawn:  8:43 

Yeah, we’re Yeah. Well, there’s a whole transition from being born. A baby has been growing inside the mom’s womb for nine months, and has been getting all of its options, oxygen supply for mom, all of its nutrients for mom, kidney function, liver function, all of that is being regulated by mom, and the baby has like take on that responsibility for their own physiology in a fairly short period of time.

Jamie:  9:18 

You expect much from newborns?

Dawn:  9:19 

I know well. Yeah, well, we’ll talk more more about that. You have a level three and level four, and ICUs. And that’s usually I think, what people think of when they think of NICU is is this level three or level four. Level three NICUs. Can handle babies that are that are born premature, that have critical illness, severe medical complications. They usually offer really the full the full range of, of pediatric medical specialties, respiratory support. MRI and that sort of thing, a level four NICU, that’s like the highest level of care for babies. So, sometimes what you’ll see it at a level four is maybe a baby needs surgery, for birth complications, you know, the maybe we already know that the baby has a cardiac defect that needs to be addressed surgically. So usually, those babies will end up in a level four, because you need to have, you need to have a surgeon on hand that is able to operate on a preterm baby or full term baby and be able to deal with those types of cardiac issues. We have babies that need to the due to due to kind of like anomalies in their anatomy, that it just needs to be addressed right away, or they need to be monitored and taken care of medically from a specific standpoint. And so those babies will typically end up more at a level four regional NICU, then then a baby who just needs to be monitored, or, you know, might just be running a fever. And we’re not sure why. You may see babies get transferred from one unit to another and we start off in the newborn and go to the newborn nursery because they need more specialized care. And then if the baby kind of has more increasing problems end up on a level three or level four NICU. Right. So sometimes when we’re training, we do have the ability to transport babies from locally, there is a level four NICU that has the ability to transport by helicopter, babies born at some of our more rural parts of California that don’t have level three or level four for NICUs. And, and fly them in. Oh, wow. Yeah, so it’s, nobody ever everybody was nice of like, you’re pregnant, you have your baby, and you go home, and everything is fine and right. Time, obviously, that that’s what happens. But unfortunately, sometimes things go, things don’t go as planned. And you need to have a higher level of medical support than, than you thought.

Jamie:  12:18 

Yeah. So So what is so what is your role then as an occupational therapist in the NICU. So the primary role

Dawn:  12:30 

is developmental handling, positioning, positive touch, and then feeding. And so and then both of those roles kind of encompass their own set of set of responsibilities. So depending on the depending on the baby, so if I’m working with a baby, who is considered to be a small, a small baby, so they’re born less than 28 weeks, so between 25 and 20 weeks gestation, once they’re, once they’ve been in the unit for a certain amount of time, sometimes it’s like about a week, sometimes it’s longer, and they reached a certain level of medical stability, then, then we start to go in and just kind of do some positive touch with what’s called containment. So you really just kind of put your hands on the baby and and don’t move. Okay? A lot of which we tried to encourage as early as possible that kangaroo care. So it’s the skin to skin contact with a parent, it doesn’t. It’s, it’s nice when it’s mom, and it’s preferable when it’s mom, but it can also be dad, and if the parents aren’t available. And there’s a surrogate parent involved, like a grandparent or or close or another family relative or close family friend that the parents have said, yes, we want them to do this for our child. And to start doing that as as early as possible. There’s a lot of poking that happens with these poor babies, you know, they want to have IVs, they are on breathing support. They have to their heel stick done, blood gets drawn. So there’s just a lot of things that happened that are life saving, and they need to happen, but they’re not necessarily positive experiences for the baby. So we also want to go in there and make sure that the baby’s experiencing positive. Positive touches is basically the term that we use when they get a little older and they’re more able to handle and we will start doing some infant massage. We used to start with the feet and kind of and work our way up closer to the body. We teach parents how to do that. So they’re they’re not just the idea with the positive touch and the kangaroo care and the infamous lodges that you’re not just coming to like stairs your baby while they lie either in an open warmer or, or an isolette that you’re actually participating in helping your child develop while they’re while they’re in the NICU.

Jamie:  14:59 

You So you just mentioned a warmer and an isolette. So it’s a warmer is that literally just like,

Dawn:  15:07 

it’s that open? Yeah, well, it’s, it’s, it’s an open, it’s an open bed, but it’s got a heat lamp. And it will, there’s ability to monitor the baby’s temperature through. Through through the bed itself, there’s a light above it, it so it’s got some things that go along with being in and out maybe one we’re that allows the medical team to properly care for care for the baby. So the, the light, the heating lamp is kind of like automatic. So the baby’s temperature, it’s, it’s programmed to the baby needs to keep the temperature of a certain of a certain degree. And then it’ll it’ll monitor if the baby starts to get cold, it’ll like kick up the heat a little bit. If the baby starts to get too warm, it’ll lower itself down. So yeah, so it’s, it’s more specialized than just putting like a lamp over the baby to keep to keep the baby warm. But just sometimes you’re giving them a bath and the NICU right you will get them they will get a lamp just so that it’s warm, and we’ll give them a bath, because we don’t want to get them back where they belong and get their temperature. You know, more stable again, the isolette is the enclosed is the enclosed bed, the air coming into that bed is filtered. The temperature is also regulated in sun inside the isolette too. But and it also does some other things like minimize noise. And then you can also minimize light. Because when you have your premature babies, you know, they’re supposed to be in utero they’re not they’re not supposed to have been born yet. They’re gonna have a hard time regulating their temperature. We don’t want them overexposed to sound we don’t want them overexposed to light. So we put them in these isolates and we try to kind of you there’s no mimicking the womb. Like, yeah, but you but you want sound muffled you want like muffled? Yes, as as much as you can. So and then the other thing that we do as OTS in the NICU, NICU is work on feeding, that that’s also something that a lot of families don’t realize, or a lot of people in general don’t realize I you know, go to a party, and they’re like, What do you do? And what do you do there, and it’s like, oh, I, I work with babies, because I have to learn how to eat and everyone always takes a double take. But babies are born knowing how to eat like, well, they’re born knowing how to eat when they’re full term, and they don’t have any medical complications, when they’re born prematurely, or there are significant medical complications. Eating isn’t doesn’t come as naturally as, as it should, because they’ve got these other factors interfering with their ability to coordinate, suck, swallow and breathe. And so they need, they need help in that area. And that’s a significant role for for OTs and and ICUs.

Jamie:  17:49 

So how, I don’t know if you can briefly tell us how you teach a baby to eat? What how do you start? I mean, do you just like massage?

Dawn:  18:01 

Well, first, first, it starts with an assessment. You know, there’s there’s specific gestational ages that you expect to see. Sucking, you know, I wouldn’t, wouldn’t necessarily and the baby also then needs to be able to tolerate being touched. So we’ll know going in that, you know, if a baby has problems maintaining their heart rate and their oxygenation, when you go in and change their diaper, they’re probably not going to handle anything in their in their mouth. And so we kind of have to build up that tolerance for handling. So that’s kind of the the overlap with the developmental, negative and positive maturity to handle with a need to handle handling. And are they sucking? You know, do they do they have that? That’s like reflex? What, what are we doing to to get that going. So with our premature babies, around 30 weeks or so, we’ll we’ll start really kind of looking at quality of Salkind and endorphins, you know, and usually we’re just happy with a couple of socks here and there. We don’t expect newborn sucking at 30 weeks, and around 33 weeks or so. And that’s those these are rough ages because each baby is going to be a little different. We may start doing something called Taste trials, where we have a baby who does suck well on a pacifier or gloved finger. And so we want to make sure that they’re also then able to swallow and we’ll do like, like, what five CC’s is a teaspoon. So we’ll start sometimes with a half a cc. So I mean, I don’t even have to measure that in teaspoon. So this is so tiny. And just to make sure that they they’re swallowing Okay, and we’ll do that a couple of times a day and just kind of then work up to between their the gestational age that’s appropriate for Feeding and Swallowing and what they’re able to and what they’re able to handle and kind of work on that together. If we have a baby who’s not able to swallow safely by about like that 36 to 40 weeks around that full term age, we may start introducing neuromuscular electrical stimulation to the muscles of the of the throat to kind of help facilitate a stronger swallow. Depending on overall neurological status of the baby, respiratory status, you know, we, you have to have that suck, swallow breathe, which means you have to be able to breathe, okay, so some of our babies because their lungs been compromised from being born early, breathe too fast or need supplemental oxygen oxygenation in order to breathe. I always try to work with the parents and say, think about walking up a flight of stairs and getting out of breath. And then my telling you, you have to drink this bottle of water while you continue up another flight of stairs. You can’t do it. Right? Read to fascinate at the same time. And that is a significant problem with a lot of the babies that are born early, especially if there’s been respiratory damage, or their respiratory issues and that they’re breathing too fast. And so they can’t safely eat. And so that becomes a Can we can we work on building endurance? Or do we ultimately need to make a decision about a child needing a feeding tube in order to go home and safely be fed? Wow. The same is true. Sorry. And these can happen across the board like our kids that have neurological issues. So maybe there has been a brain bleed or maybe their seizures and so can they maintain that sucking and safe swallow? Cardiac. babies that have cardiac problems can also have the same problem with coordinating, suck, swallow and breathe because the heart can affect your respirations. If the heart’s not pumping efficiently, then sometimes we read too fast to compensate for that. Excuse me?

Jamie:  21:44 

Yeah. Wow. So it sounds like that you you spend a lot of time with each of your patients. When it’s when it’s a eating issue, or sucking swallowing? How often when when you go and see a patient, how often do you see them and how long generally do the sessions last?

Dawn:  22:09 

What we usually do. So each hospital is going to be different in terms of the frequency of a therapy services. And some of that’s going to depend on on the baby. If we have a baby, that is it’s kind of low endurance, maybe we’re going to do an assessment and set up feeding strategy so that everybody kind of knows, okay, this baby gets tired quickly. And these are the strategies that work best. There are different kinds of nipples, bottle labels that we use some flow a little faster than others. And so for some babies, we’ll have them on the slowest flow possible, because that helps them with with their swallowing. We also like work on breastfeeding, but we can talk about that later. So we don’t usually want a baby to eat for longer than 20 to 30 minutes, depending on their overall condition anything longer than that. They’re just burning calories and they’re getting, and we’re just fatiguing them. But the therapy session may last longer, depending on what else we’re doing with them. The session is usually I would say unless I’m doing an intensive family training, my sessions are anywhere from a half an hour to an hour. But if I am working with a family who has lots of questions or needs more support, that session may go longer, but that’s not. That’s not typical. Okay. Then, then again, depending on the baby, and depending on the hospital, I may be seeing the child five days a week, I may be seeing them three days a week, I may it may be an evaluation and just was like, You know what, they don’t really need us. So we’re not gonna see them at all. So it is very individualized. Because I work on Saturdays, I’m usually seeing the children, the babies that are having significant issues with feeding. And we’re giving that extra therapy sessions are usually Monday through Friday. So if they’re being seen on Saturday, that is because they need extra support to get to get the eating going.

Jamie:  23:59 

Okay, that makes sense. That makes sense. So it sounds like there, there would be some overlap and services in with with these patients. Is there like are there other? Are there other services that are going to be helping with like the feeding aspect and

Dawn:  24:20 

yeah, so it again, it’s gonna depend on the hospital. So some hospitals have just ot that works in the NICU, some will have PT, some might have speech, and some have all three. So our OTA or actually, our licensure law in California states that I can only treat a patient that’s been evaluated by an OT, so we so usually end up splitting, kind of splitting the caseload, taking turns treating treating patients so you’ll get so maybe PT seeing a baby, but they are like you know what, there’s some sensory issues that are going on. We want ot to come in. OT might start feeding start Feeding a patient that has some specific learning goal or pharyngeal issues is like, you know, let’s get speech therapy involved. So we you have to work as a team, because you don’t want to, you don’t want to have duplication of services. But at the same time, you want to make sure that the baby is getting all the services that they need. We do also work with lactation consultants in the hospital with getting the premature babies and the babies that are medically fragile up in eating. And so if I know that lactation is going to work with mom on Tuesday, then I’m not going to treat that patient on Tuesday, I’ll come in on on Wednesday and do something else or I’ll work with her on the bottle feeding and let the lactation consultant work with the mom on breastfeeding. So it’s sometimes it’s the need of the patient, maybe they need a lactation consultant to work right now with the with the family and there’s not one available. So I’ll just step in and do it. Some of the some O T’s and some speech therapists are also licensed lactation consultants. That there’s there’s, you know, and some are also certified in infant massage. So there’s, there’s a National Association of Neonatal Therapists and and so there’s lots of people who have additional certifications besides their their, their primary PT, OT, or speech therapy license.

Jamie:  26:20 

Okay, all right, you just answered my next question with which was, what kind of special training do you need?

Dawn:  26:28 

there right now, there isn’t a specific, like certification course to be an ICU therapist. However, nobody’s going to hire a therapist to come work in their unit that either doesn’t have experience, or they don’t offer some sort of mentorship program. So typically, to even be able to be considered for an NICU position, you typically have to have at least two or three years experience some some facilities want five. And then usually your your, your shadowed, which means you’re following the primary therapist, and then as you, you know, get better at some of your skills and learning about what to do with the babies. Premature babies have a, they’re not just small newborn babies. They’re, they’re still developing as though they would be in utero. So their sensory system is different. Some babies, if they’re born early enough, their eyes are still fused, they haven’t been able to open their eyes yet. So there’s, so you need to be able to know how to how to assess where the baby’s at, and what kind of handling they can they can they can tolerate. Because you don’t want to go in and treat 30 weaker as though they were just a small full term, baby.

Jamie:  27:52 

Yeah. So how long have you been in occupational therapy before you started working in the neonatal unit?

Dawn:  28:03 

That’s a good question. Let’s see, I’ve been an OT for 33 years, and I’ve been in the NICU for 24. So you can do the math.

Jamie:  28:20 

Wow, okay.

Dawn:  28:25 

And then even with that training, the facility at the hospital I was at at the time did send me to and and then I see you at another hospital for for a number of I forget how many it was, that was back 22 years ago that I didn’t go to another hospital for like that shadowing and for that initial training. And then we did have a one therapist who had had a NICU experience that then continued that, then continue the training. Oh, okay. So yeah, I mean, I’ve done I’ve done training for, like new staff who wanted to come in. And usually, like I said, they have several years experience. Having inpatient experience is always good, because it’s, it’s nice to be comfortable around, you know, the nasal cannula or patient on a ventilator, or just, you know, the lead wires that are monitoring heart rate and respirations. And oh, two saturations and that kind of stuff. And so it can be a little, it can be a little nerve wracking, even as a therapist to go in there and be like, I have to do what and like, look at all these lines. So having that kind of experience helps also and it take, you know, I mean, like, even even having done this for 22 years. The thing that’s incredible about medicine is that they’re always finding new ways to help people. So every now and then I will get a patient and they’ll be like, I’ve never heard of this diagnosis before and I’ll have to go back to my team and be like, you know, what are we doing here? So there’s, there’s there’s always learning that that that has to that has to happen. We do have Typically, you would have somebody representing the therapy team at rounds, you know, when the doctors are kind of going over the the general case caseload so that you’re getting your education from the doctor, like, oh, we have this kiddo they’ve had this surgery is the first time we’ve ever done this, this is what you should see, if I’m seeing something that hasn’t, you know, that doesn’t, that I’m a little concerned about. Either go straight to the doctor and have a conversation with them. Or my team member who goes to arousal will bring that up, like, Hey, we’re seeing some swelling we didn’t think we were supposed to and it’s like, oh, no, it’s fine. Don’t worry about it. Okay. Okay, you know, you’re working. So it’s, you’re not working, you’re not working in isolation. You’re part of a team. And people want to know how the how the baby handled your session, you need to know how the baby handle other people’s sessions, you really have to have a great relationship with with your nurse. Because, you know, if your nurses like, Hey, I don’t know that today’s a good day for for intervention, we hadn’t this and this happened this morning, then you need to be able to go there said no, and and be okay with that. And not. And not try to challenge anything.

Jamie:  31:11 

Okay. So there’s a lot of trust amongst the different providers of the various care. It sounds like there has to be a lot of trust in order to get this to work.

Dawn:  31:24 

Yes, well, because if your nurse doesn’t trust you, she’s not going to let you touch your patient. And then you can’t help your patient. You know, the parent doesn’t trust the nurse, then, you know, then they they’re just anxious. And they can’t they’re not open to, to learning because their their concern is is somewhere else.

Jamie:  31:44 

Okay, yeah. Yeah. So can you tell me about some of the successes that you’ve had with treating this this population?

Dawn:  31:56 

Um, so that’s kind of interesting.

Jamie:  32:01 

They’re all successes, they get to go home, right?

Dawn:  32:06 

Okay, yes. Is so is a success. A child doesn’t need the feeding tube, because the he completely wasn’t successful. A child does go home with a feeding tube, as well, you know, especially if you have like a plan in place and the family’s comfortable and the child is still making progress. So I think that a success for me as a treating therapist in the NICU is that I’ve been able to make a relationship with a family, that they feel that their experience with me in therapy and their child in our facility was as positive as possible, right? Nobody wants to have a child born in the NICU, nobody wants one that has medical complications are great. I can get a parent to leave, and at least be able to look back on their experience as being as positive as possible. And I actually consider that to be a success. Because they don’t, right. Not only do what they can do and to and to kind of like put that on. And to put that expectation. It’s just not fair to the family or the baby.

Jamie:  33:08 

Yeah. Okay. Yes, I guess really my question, what was that? Were were there any examples of a baby that you thought was the did even like much better than you expected that you know, just

Dawn:  33:22 

that happens? Unfortunately, babies it like, why aren’t you doing better, like this doesn’t make any sense. And you have other kids that are just like, wow, but really where you see those, I guess, successes then would be when they they there are certain criteria that a baby has to meet. And almost all of our preterm, anyone born under 32 weeks automatically meets that we have a high risk. Follow up clinic most most hospitals have had are required, at least in the state of California for certain types of funding, to have some type of high risk follow up clinic so that babies receive developmental assessments at around six months of age adjusted. So you’re born three months early, you might be nine months, but adjusted to six months, and then you’ll get your first developmental assessment, then you come back at around 15 to 18 months, and then sometime after two, and we do these developmental assessments. And sometimes you’ll see kids that come back and you’re just like, wow, I as sick as you were as complicated as you were, you know, like, look at what you’re doing. I have had some kids come back that I was just kind of surprised at some of the struggles that we’re having. And then sometimes you’re just kind of pleased with how well somebody is doing for just what was expected of them. So we have had some kids that were not expected to be very interactive because of just because of their medical, the level of medical complications, and they’re able to interact with their family on that level that they’re able to do in the family and they’re able to bond with their parents and parents are able to bond with them. And so that is awesome. I would say I would consider it to be a success when a family comes in, and they bonded with her with their child as well as those measuring those developmental outcomes. How OT is that?

Jamie:  35:12 

That was very OT

Dawn:  35:15 

like, but it’s true at the same time, it’s like you nobody ever wants to take away from somebody for not be, you know, for not being somebody else, you know, you you want somebody to thrive and being who they who they are. And it’s the same for these these kiddos. That’s why I like that question. I kind of like I did kind of get stumped on when I was. Oh, it’s not how we see things.

Jamie:  35:41 

So, are there any other any other? We’ve talked, you know, throughout this interview about some challenges of facing the population? Are there any other challenges that you you want to talk about work? Or maybe just want to give some advice to families that have a child who’s having some sort of incident?

Dawn:  36:05 

Well, you know, I think it because it’s a kind of a combination of both? Both those questions, our biggest challenges tend to be families that don’t communicate well. You know, so, I mean, I, I’ve been in a room where a surgeons come in, talk to the mom, and, you know, ask, Do you have any questions? She said, No, and then leaves and then gets on the phone with her husband is like, surgery was here, I didn’t understand anything. He said. And I’m like, No, that’s not okay. You know, and then to join it, then surgeon to come back in the room is just a lot of work. And, and, and there’s a lot of, you know, it’s sometimes it’s hard when you’re, when you’re in the medical field, and you’re in this kind of like, level of medical care and the terminology that gets used to sometimes slip into that jargon. I’m sure I did that, like 500 times during this interview, like, I wasn’t going to do that. You know, and then to realize that people don’t know what you’re, what you’re what you’re saying. And so it’s it’s important to be able to that the family be able to ask those questions, and get in and get those answers so that they feel they have to feel comfortable with their baby in, in the hospital. So you’ll have families that are not comfortable. And they’re there 24/7. And they’re, and because they’re so anxious, it makes for difficult communication, or you’ll have families in the other extreme, they’re not comfortable with what’s going on. And they’re scared, so they disappear on us. And that’s not okay, either. You know, something in the middle is is, is ideal. And I get people don’t want other people knowing like their business, but it’s helpful if the your nurse knows that you’ve got three other kids at home and no transportation, and nobody can and no babysitters, rather than everyone thinking, we’re this mom go this, you know, is she taking the baby home? Like we have? No, she hasn’t called, we haven’t heard from her. She’s not responding to her phone calls, when it’s like she’s trying to deal with this personal crisis, and doesn’t want us to know what’s going on, you know, for, you know, and so I would say you, you kind of need to. Because once because there are things that we can do to help, there are a lot of hustles of Irana McDonald homes. So if you live far away, or you, you don’t have great transportation, maybe we can get you in a Ronald McDonald House, pre COVID. A lot of a lot of hospitals had not babysitting, but they did have like play rooms for siblings of a certain age. You know, Dorian COVID. And I don’t know that any of them have opened up just yet. But hopefully those will come back. But if we don’t know you need to help them do it, especially for I know for sure for moms who are breastfeeding, but sometimes for other families as well. They’ll give vouchers so that you can go get lunch at the cafeteria so that it’s not like you disappeared for four hours because she had to eat something and you needed to go home to make a sandwich because you couldn’t afford.

Jamie:  39:03 

Okay, cafeteria, so you don’t have those things. And,

Dawn:  39:07 

you know, we’ve done cat vouchers and what’s vouchers to just to, but like I said, if we if we don’t know there’s a problem, then we can’t know we can’t help out. So communication, I think is the biggest challenge,

Jamie:  39:22 

okay. Really want to know their business? I mean, it’s like, please know, tell us everything. Leave nothing out. And then we’ll decide what’s important.

Dawn:  39:34 

Well, yeah, I mean, I don’t we don’t need to know that you got to do a fight with your husband last night. But yes, it’s like or your spouse I should say.

Dawn;  39:44 

It’s just sort of, like, Yeah, we don’t need to know. I mean, sometimes we find out that information as well, like, who’s arguing with you and who’s not allowed to come visit and who knows what, but if it affects the care of the child in the hospital, then it is important that we know Yeah, and then just Other big challenges that because most premature births or most traumatic births are not expected, there’s just a lot of anxiety, anxiety and even sometimes anger issues, you know, involved there too. And a lot of just a lack of understanding. No, not not understanding like, okay, my baby was was born this way, how come they’re not eating and then having to explain? Well, they’re, they’re breathing too fast. Well, that doesn’t make any sense. All babies eat Okay. And, and so we do have to deal with that issue a lot, too. We’re just a kind of a general lack of understanding about anatomy and physiology. And in neurology and the impact on like, how how we function, sometimes it’s it’s somebodies first introduction to


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