Vulnerable Neonates Deserve Respectful Care
By: Rose L. Horton, MSM, RNC-OB, NEA-BC, FAAN
Huggies Healthcare Executive Director Maternal Health
I was honored to join colleagues at Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) in their pioneering work on Respectful Maternity Care (RMC). AWHONN stood up the Respectful Maternity Care Evidence Based Guidelines and Toolkit at the AWHONN Leadership Conference in January 2022. Huggies Healthcare funds this work.
It was easy to say yes to joining the project, as our Emory Decatur Hospital team had been intentional on focusing on respect starting in 2019. The work we did at the hospital was super impactful and led to our journey towards equity. What we learned in creating the Respectful Equitable Care work was that we had so much more to learn and more to do to ensure that our organization was living its mission, and that we were creating psychologically safe spaces for the birthing community: one that honors the sacredness of birth, the value of fathers and partners during the birthing process, and the vulnerability of the neonate.
Fast forward to Synova NICU Leadership Forum 2023 where I had the wonderful pleasure of hearing Sue Ludwig’s presentation and subsequently reading her book Tiny Humans, Big Lessons.1 After 15 years as an executive leader of the Women & Infant Service Line, I never stopped and thought about disrespect in the NICU of the neonate. There is obvious and overt disrespect which shows up as rough handling or calling the neonate a disparaging name, something, thankfully, that I have not witnessed often. What I was not cognizant of was the covert, less obvious and equally damaging disrespect that is beautifully described in her book and that is what I want to highlight in an effort to nurture, support, love and protect the neonates in the NICU.
The importance of respectful maternity care is a topic that has received increasing focus among clinicians, researchers, and the public in recent years. Healthcare organizations and clinicians see the value in providing respectful care. The concept of respect is embedded in the American Nurses Association nurse’s code of ethics, “The nurse practices with compassion and respect for the inherent dignity, worth and unique attributes of every person.”2 Respectful care in the maternity setting is defined as, “care organized for and provided to all women in a manner that maintains their dignity, privacy, and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth.” To that end, I partnered with a few colleagues to publish an article on this very topic: https://connect.springerpub.com/content/sgrnn/43/6/375.
Effective transformation requires consistent respectful care throughout maternity services. Meaningful changes occur when RMC permeates the entire maternity care culture, within the context of patient outcomes and targeted policy-level changes within the workplace and the community. Neonatal care is inherently a part of the maternity care continuum. As such, application of the AWHONN RMC Framework must occur not only on Labor & Delivery floors but within the walls of Neonatal Intensive Care Units (NICUs) as well.
What Sue highlighted in her book is that as humans, though NICU professionals, sometimes there are conversations over the incubators or bed spaces, over the neonate, about things that have nothing to do with the infant. Sometimes those conversations include venting, complaining, or gossiping. Though not necessarily loud enough to cause overt stress, that is not the energy that fosters a nurturing and healing environment for a fragile baby. NICU nurses may consider asking themselves, “Are these conversations representative of conversations we would have in an adult, alert and oriented patient room?” This statement was a huge aha moment for me. I cannot recall the countless times, during leader rounding in the NICU where I would engage in a whole conversation with the nurses while they were caring for a neonate. I would ask about their day, family, current events, so many things, and none of it had anything to do with the neonate. What I intended to be a moment to connect on a meaningful, spontaneous level with the nurse, was possibly causing harm to a neonate.
I love the quote from the imitable Maya Angelou, “Do the best you can until you know better. Then when you know better, do better.” I have always been super intentional about the energy that I bring into the space of a woman in labor. I speak about this often. I am committed to entering that space with the best energy because vulnerable neonates deserve respectful care . . . will you join me?
References
- Ludwig S. Tiny humans, big lessons. Unabridged. ed. United States: Page Two Books, Inc; 2022. https://www.hoopladigital.com/title/15914798?utm_source=MARC&Lid=hh3859.
- American Nurses Association. Code of ethics for nurses with interpretive statements. 1st ed. Silver Springs, MD: American Nurses Association; 2015. https://ebookcentral.proquest.com/lib/[SITE_ID]/detail.action?docID=5194578.
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