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Don't Forget to Ask About the NICU

My second daughter was born via a planned repeat cesarean section at 39 weeks of pregnancy. She had a little bit of trouble breathing due to fluid in her lungs and required a brief stay in the neonatal intensive care unit NICU for supplemental oxygen. I was lucky as she was a big healthy baby and I delivered at the hospital where I am an obstetrician. I knew that the NICU staff was taking excellent care of her, and just as importantly, it was not my fault nor had I done anything wrong to cause her to need to go to the NICU.

Whether anticipated or not, there is always a chance that your baby may need to go to the NICU after birth. You may know well in advance that the baby will need to go to the NICU after delivery. You may have had a preterm birth before and are at higher risk for recurrence, have other risk factors for preterm birth, or have pregnancy complications that you understand will lead to a NICU stay after birth. You may develop a more sudden preterm complication such as breaking your water, heavy bleeding, preeclampsia, or the baby growing very small (severe growth restriction) that requires an earlier delivery and a plan for direct admission to the NICU. It may be a complete surprise, such as in my case, when after birth it is determined the baby needs to go to the NICU.

No matter the situation, if you are pregnant you should be prepared for the possibility that your baby may need to go to the NICU. I do not say this to scare you. Many patients have told me this is something they had never thought about during pregnancy but in retrospect, after their baby went to the NICU, they wished they had. I now tell all of my patients about the NICU at the hospital where they will deliver and encourage you to ask your obstetric provider as well.

Below is a brief description of the four standard levels of newborn care which will prepare you for this conversation with your provider.

Level I: Well newborn nursery

Even if your hospital encourages rooming in, they will have a newborn nursery. You should always have the option to ask for your baby go to the nursery if you need sleep and recovery after a long labor or c section. Also, if the baby has jaundice and needs to receive light therapy or is getting their bloodwork and newborn testing this may occur in the newborn nursery.

Level II: Special care nursery

Often referred to as “stepdown care” as babies who were in the NICU after birth may transition to this lower level of care before being discharged home. There are other situations where a baby may be directly admitted to the special care nursery after birth so that they can be monitored a little closer. They may then transition to the well newborn nursery care or may need to have their care escalated to the NICU depending on the situation.


Even hospitals that have NICUs vary in the gestational age that they will admit babies depending on their staffing and what special circumstances they are able to support. For instance, the cutoff may be 28 weeks and if your baby is born at 26 weeks they will be transferred to another hospital for specialty care. Sometimes mom may be transferred with the baby but other times she must wait for her own discharge before joining the baby.

Level IV: Regional NICU

These NICUs can typically support all babies from viability, which is the earliest age when they can possibly survive outside of the uterus. They also have specialty services like the ability to perform major surgery and can care for complex cardiac anomalies and other conditions that require extracorporeal membrane oxygenation (ECMO). If you know ahead of birth your baby will need these specialty services it will be coordinated in advance for you to deliver at a level IV NICU.

Having a baby in the NICU is often very overwhelming and traumatic for parents, even if they were prepared and knew their baby would be admitted in advance. Perinatal mood and anxiety disorders are also more common in NICU parents. There are a lot of great support groups and books specifically for NICU parents. I also recommend finding a therapist who specializes in perinatal mental health to work with you and your partner- these specialists understand the intense demands and stressors that NICU parents commonly face. Postpartum Support International (PSI) is a great place to start looking for support groups and local therapists. If you have a baby in the NICU or know in advance your baby will require a NICU admission the The March of Dimes also has excellent free resources including materials to educate parents about what it is like to have a baby in the NICU.

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