Ben Courchia MD

Okay, and so for this next segment, we are joined by two impressive guests. Daphna, we have the pleasure of having on the podcast today, LaToshia Rouse and Jessica DiBari. LaToshia, welcome to the podcast.

LaToshia Rouse

Thank you for having me. Glad to be here.

Ben Courchia MD

I'm glad to have you on. You're a certified doula at Birth Sisters Doula Services and a patient engagement consultant in Knightdale, North Carolina. Your perspective is a very valuable one and a very interesting one. Jessica, welcome to the podcast. For those who may not know you, you are the acting director in the Division of Research in the Office of Epidemiology and Research at the Maternal and Child Health Bureau of the Health Resources and Services Administration. Thank you for making time to come on the show.

Jessica DiBari

Thank you for inviting me.

Ben Courchia MD

So you both co-authored two very interesting viewpoints in this special series. They're called Parent Perspective. There's part one, “Considerations for Changing the NICU Culture,” and then there's a second part called “Considerations for the Transition Home Post-NICU Discharge.” I guess we should begin in order and spend a bit of time on part one, where you tackle the possibility of changing the NICU culture. My first question to you both, is how do you tackle the pretty significant problem of defining the NICU culture?

LaToshia Rouse

So having had the experience, I think defining it from a patient's perspective is like going into a foreign land and learning a new language. The way that they speak, the sounds, the smells, the way that they interact – it’s almost like going to a new country that you didn’t choose to visit, and you’re having to learn how to navigate it. That’s part of the culture shock of entering the NICU. The people there see this every day, but you don’t. Everything that’s routine to them feels alarming to you, because you’ve never seen a baby on this much equipment. It’s difficult to know what’s worth worrying about and what’s just normal in that environment.

Jessica DiBari

I couldn’t agree more. Families are thrown into this culture and experience culture shock. The baby is in a sensitive period, but the families are as well. They’re vulnerable, emotional, and coping in different ways. Providing support to help them ease into this new normal is critically important.

Ben Courchia MD

In the article, you identified several themes or domains that help us understand NICU culture: psychological distress, early bonding and attachment, setting the tone in the NICU, creating a nurturing environment, and collaborating with families. What are the takeaways about the current state of affairs in the NICU with respect to these themes? Jessica, do you want to start?

Jessica DiBari

Sure. It’s important to recognize that birth traumas can cause psychological distress, and early bonding and attachment help families cope with that distress. Setting a positive, optimistic tone in the NICU can change how the experience is perceived. Normalizing the hospital environment and creating a nurturing atmosphere while supporting and collaborating with families, ensuring constant communication and aligned priorities. My takeaway is that we must use that intensive period to teach a growth mindset, build trust with providers, and establish networks of care coordination to support the transition home. Screening for anxiety and depression during that time is also critical.

LaToshia Rouse

Yes, and I think setting up support is also vital. I volunteered in the NICU for three years as a parent support advisor, helping families bond with their babies. Holding a medically fragile baby can be intimidating. I often say, “You have to hold the mother while the mother holds the baby.” Parents need support, too. Teaching them how to bathe, dress, and talk to their babies - all of that helps bonding. And how information is delivered matters so much. When explaining possibilities, do it in a way that leaves room for hope, not just fear. Frame it as, “Here’s what’s possible, here’s what’s likely, and here’s what we can do.” That approach helps families focus on nurturing and supporting their baby’s development both in and beyond the NICU.