Ann, I sent your request for NICU remodeling ideas to Mara Stein, who had
posted an eloquent message about family-centered NICU care on NICU-NET.
Here's her response, which I thought you and everybody else on lactnet
would like to see:

Ginna Wall, MN, IBCLC, Lactation Services Coordinator
University of Washington Medical Center, Mailbox 356153
1959 NE Pacific Street, Seattle WA 98195
Voicemail: (206)548-6368, Fax: (206)548-7665

---------- Forwarded message ----------
Date: Tue, 28 Oct 1997 23:37:46 -0500 (EST)
From: [log in to unmask]
To: [log in to unmask]
Subject: Re: Your message on NICU-NET

Thank you so much for your note!  I am so glad to hear about people trying to
make innovations in NICU's that will benefit families.

I would love to contribute some ideas...I need some time to put them
together.  One thing that I think would be helpful for your colleague would
be to post her question to the preemie-list (a listserv of parents of
preemies, professionals, and others interested in issues @ prematurity).
 These parents have experiences NICU's around the world and would have a
great deal to offer regarding the elements in their units which were
particularly family friendly, and what elements they would like to have seen.
  <A HREF="http://yarra.vicnet.net.au/~garyh/preemie.htm"> Preemie-l Discussio
n Group</A>

I really think that true family-centered care does more than just give lip
service to these values.  The staff needs to think long and hard about what
they are willing to do and how they plan to approach families -- what do they
believe about what is important and what do they think that families need.
 If they don't know, then they can start to watch and ask and pay attention
to these areas.   Based on these beliefs and values, NICU staff and
administration will make decisions about their design and structure.

With regard to your colleague's specific question about accommodating
nursing...Speaking as a parent of preemies...a mother who is still pumping at
17 months (one of my babies nurses and the other does not) I do have some
thoughts about what is important to facilitate nursing in an NICU (probably
nothing that hasn't already been thought about, though).

1)  A bedside arrangement that incorporates either a curtain or partitions
that provide genuine privacy for nursing (rather than flimsy screens which
don't provide coverage, and which are difficult to set up and keep in place).

2)  Provide chairs and pillows (nursing pillows, if possible) that allow mom
and baby to be properly positioned for nursing.  Being stressed and
uncomfortable makes it virtually impossible to encourage a baby to latch, or
for letdown to occur.

3)  Pumping rooms that have all necessary equipment, a sink, a rocker and
reading material -- a room that is soothing and welcoming to a mom who is
probably not looking forward to using it...keep bottles and nipples in there,
as well...it would make it easier for moms to transfer their milk to the
sterile bottles if they are easy to access.

4)  Having a lactation consultant available on a regular basis for "coaching"
a mom and preemie who haven't yet "caught on" to nursing would be invaluable.
 Having someone show you once or twice just isn't enough.  It is a tremendous
struggle to learn to nurse.  It is easy to become discouraged.

5)  Teaching nurses about finger-feeding preemies (and really advocating this
method -- I could see nurses resisting because they may believe it's "too
much trouble.").  When parents are told that babies must nipple completely
before being discharged, it is easy to decide to give them bottles while they
are still learning to nurse.  This, obviously, creates its own new set of
difficulties.  I wish that someone had suggested finger feeding -- the girls
could have eaten by mouth, but not been presented with rubber nipples.  They
were still not nursing at discharge.

I hope that those initial thoughts were helpful.  I would encourage you to
check out preemie-l as well.  Please don't hesitate to contact me anytime!

Warmly,

Mara

Mara Stein, Psy.D.
Clinical Psychologist/Researcher
Mom to Gavriella and Layla -- 30 weekers, now almost 17 months old
Chicago, Illinois