Obstetrician

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Embryologist
Neonatal Nurse
Caesarean birth (C-section)
A Day in the Life of an Embryologist

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Clerical or OrganisingAnalytic or ScientificSkill Level 6

Obstetrics known as obstetrics and gynaecology (O&G) deals with women's health. Australian obstetricians are also gynecologists, meaning they treat all women’s health concerns. The two disciplines comprise the OB/GYN title, which is considered a single specialty.

An obstetrician is a medical practitioner who offers preconception, pregnancy, delivery, and postpartum medical and surgical treatment. Obstetricians are responsible for the health of mother and fetus during, before and after pregnancy. The role can vary from monitoring normal pregnancy to quick decision making during obstetric emergencies such as severe pre-eclampsia or postpartum haemorrhage. Future Growth Strong

Obstetrics is strongly linked to gynaecology - diagnoses and treatment of disorders of the female reproductive system.

ANZSCO ID: 253913

Specialisations:

  • maternal-fetal medicine MFM - Obstetricians in Australia are also capable of specializing in maternal-fetal medicine (MFM). Doctors with the MFM subspecialty concentrate on chronic health disorders and abnormal pregnancy complications.

  • medical genetics and genomics (MGG)

  • reproductive endocrinology and infertility

  • specialise or conduct research in areas such as fertility care or high-risk obstetrics

  • teach medical students or postgraduate students in training

  • get involved in research at universities, or private sector


Knowledge, skills and attributes

To become an obstetrician, you would need:

  • excellent communication skills to manage a wide range of relationships with colleagues, and patients and their families
  • emotional resilience, a calm temperament and the ability to work well under pressure
  • teamwork and the capacity to lead multidisciplinary teams
  • problem-solving and diagnostic skills
  • outstanding organisational ability and effective decision-making skills
  • first-class time and resource management for the benefit of patients
  • a high degree of manual dexterity
  • superb hand-eye co-ordination, excellent vision, and visuospatial awareness
  • physical stamina to cope with the demands of surgery

 

Obstetrician
Obstetrician showing image of fetus
(Source: Fertility2Family)

Duties and Tasks

  • Examines patients to determine the nature and extent of problems after referral from general medical practitioners and other medical specialists, and undertakes laboratory tests and diagnostic procedures.
  • Analyses test results and other medical information to make diagnoses.
  • Prescribes and administers drugs, as well as remedial and therapeutic treatment and procedures.
  • Records medical information and data.
  • Order diagnostic imaging to identify signs of a systemic or autoimmune disorder
  • Monitor the progress of an existing rheumatic disorder
  • Prescribe medications to improve symptoms or slow the progression of the disorder
  • Perform a physical assessment to better understand the symptoms
  • Educate the patient on the autoimmune disorder and discuss a treatment plan
  • Reports specified contagious and notifiable diseases to government health and immigration authorities.
  • May admit or refer patients to hospitals.
  • May consult other medical specialists.

 

Obstetrician delivering baby surgically
Obstetrician delivering baby surgically
(Source: Fertility2Family)

 

Working conditions

Obstetricians are referred patients from general practitioners. Their practice may take place in a number of different settings including outpatient clinic, inpatient wards, operating theatres and delivery suits.

Most obstetricians work long and irregular hours. There is an on-call requirement and frequently weekend / night disruptions. More obstetricians are beginning to work part time or in job share arrangements.

Tools and technologies

Obstetricians should be familiar with a variety of tools and technologies including:

  • ultrasonography and other imaging techniques

  • fetal tests including cardiotocography

  • serum screening, amniocentesis and CVS

  • surgical instruments

  • catheters

  • neonate resuscitation


Education and training/entrance requirements

To become an obstetrician, you must first become a qualified medical practitioner and then specialise in obstetrics.

In Australia, postgraduate courses in medicine are offered by universities. These degrees usually take four years to complete. Entry requirements include completion of a bachelor degree in any discipline. You must also sit the Graduate Australian Medical Schools Admissions Test and attend an interview at your chosen institution.

On completion of the postgraduate medical degree, you must work in the public hospital system for two years (internship and residency). To specialise in obstetrics, doctors can apply to the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to undertake further training and ultimately receive fellowship.



Did You Know?

 Caesarean birth (C-section)

What is caesarean birth (C-section)?

A caesarean section (C-section or caesarean) is an operation to deliver a baby through a cut in the abdomen (tummy) and uterus (womb).

There are several reasons why you might plan for a caesarean, or your medical team might recommend you have a caesarean after labour begins.

Why might I need a C-section?
  

The most common reasons for having a caesarean are:

*concerns for the safety of you or your baby
  
*your baby is in the breech position (bottom first) and your doctor doesn’t recommend a vaginal breech birth

*your baby is transverse (lying sideways) and can’t be turned

*you have twins and the first one is in the breech position

*your placenta is covering the cervix (opening to the womb) - called "Placenta previa"

* you have had several previous caesareans

*there are complications such as severe bleeding

*your labour is not progressing

Around 1 in 3 babies in Australia are born by caesarean. This is higher than the rate in many other developed countries. This rate is also increasing, both in private and in public hospitals, although you are more likely to have a caesarean in the private sector.

A caesarean might be planned (elective) if there is a reason preventing your baby been born by a vaginal birth. Sometimes before or during your labour, complications develop, and a C-section delivery needs to be done quickly. This is called an emergency caesarean.

Your doctor will discuss the reason you may need a caesarean based on your individual situation and, in some cases, your preferences.

Diagram
(Source: Pregnancy Birth & Baby)


What to expect if you have a caesarean birth
   

You may be in the operating theatre for one hour or more. The operation takes about 30 to 40 minutes. The baby is usually born in the first 10 minutes. The doctors will talk to you during the operation and tell you what is happening.

In most cases your partner or support person can be with you. You will also usually have a midwife with you. They will look after you and your baby in the theatre and recovery area.

You will usually receive an epidural or spinal anaesthetic. This numbs the lower part of your body and lets you be awake throughout your caesarean birth. Sometimes emergency caesareans must be done under general anaesthetic which means you will be asleep during the birth.

A catheter (a thin flexible tube) will be placed into your bladder to collect urine. This is because you will not be able to get up to use the bathroom. You will have intravenous (IV) lines inserted into your arm to give you fluid and medicines.

Your tummy will be cleaned, and the obstetrician will make a cut through the wall of your tummy near the pubic hair line. The doctor will cut through layers of fat and muscle and then through your uterus. Your baby is birthed through your tummy this way. If your baby needs to be delivered very quickly, the cut may be made from just below the belly button to above the pubic bone.

The doctor will remove the placenta and close the cut with stitches or staples. You will feel tugging and pulling if you are awake but not pain. You will also hear fluid being suctioned. A screen is usually put across your chest so you cannot see what is happening.

If you are awake, you can usually hold your baby straight after your caesarean birth and begin skin-to-skin contact and breastfeeding. Sometimes the baby’s nose and mouth need to be cleared of fluids or the baby may need additional treatment from the medical team.

Who will be in the Operating Theatre ?
  

Your partner or support person will usually be able to be with you during your caesarean. There may also be a lot of medical staff, including:

obstetrician — who performs the operation and delivers the baby
 
anaesthetist — doctor who administers the anaesthetic
  
scrub nurse — passes instruments to the obstetrician
  
scout nurse — assists the scrub nurse
  
anaesthetic nurse — assists the anaesthetist
  
paediatrician — doctor who looks after the baby after the birth
  
midwife — nurse who looks after the baby until you return to the ward
  
theatre technician — looks after the operating theatre and helps you on and off the table


What are the pain relief options?
  

The types of anaesthetic used in caesareans differ. Your doctor will choose the most appropriate for you.

Epidural
  

When you get an epidural, you receive a local anaesthetic then a hollow needle and a small, flexible tube (catheter) are inserted near the spinal cord in your back. The needle is removed, leaving the catheter in place. Anaesthetic medicine is injected through the catheter and can be topped up later.

Spinal block
  

Similar to an epidural, a spinal block injects a single dose of anaesthetic directly into the fluid around the spinal cord. You will go numb very quickly, but the amount of anaesthetic cannot be topped up.

General anaesthetic
You might be given a general anaesthetic if

a spinal block or epidural anaesthetic doesn’t work
there isn’t time for a spinal block or epidural anaesthetic to be used
there are concerns for your health or your baby’s health
you request a general anaesthetic

C-section scar
(Source: What to expect)


What are the risks and complications of C-sections?
  

A caesarean is major surgery. Complications are rare but they can be serious. The risks include:

blood loss
wound infection
blood clots
possible damage to organs near the operation site, such as your bladder
risks from the anaesthetic
The risk of complications increases if you are overweight.

If you have a caesarean, your future pregnancies will be considered higher risk and there are more risks with future caesareans.

Sometimes babies born by C-section can have temporary trouble breathing. The midwife and paediatrician will take care of your baby. There is a very small chance your baby can be cut during the operation. This is usually a small cut that isn’t deep and will heal on its own.

What should I expect when recovering from a caesarean birth?
   

There is usually a slower recovery after a caesarean birth compared with vaginal birth. You may feel pain for a few days, but this can usually be treated with pain-relief medication. Usually, you will stay in hospital for three to five days.

Your obstetrician and midwife will provide advice about your recovery.


Baby delivered by Caesarean
Baby delivered by Caesarean
(Source: Pregnancy Birth & Baby)

 

Embryologist
Community and Health

Clerical or OrganisingAnalytic or ScientificSkill Level 6

Embryologists work closely with other medical professionals to perform diagnostic tests and procedures such as in vitro fertilisation (IVF) to assist patients with reproductive health issues.an lang="en-gb"> FutureGrowthModerate

ANZSCO ID: 234611
  

Knowledge, skills and attributes

To become an embryologist, you would need:

  • empathy and care for others

  • an interest and ability in science, medicine, anatomy and physiology

  • good communication skills and the ability to explain procedures to patients

  • self-confidence

  • practical skills for performing technical and clinical procedures

  • ability to carry out accurate and detailed work

  • good problem-solving skills

  • highhigh ethical standards.

Embryologist at work
Embryologist at work looking a multiplying cells
(Source: Manchester Fertility)


Duties and Tasks

As an embryologist, you would:

  • determine fertility levels of individuals

  • collect eggs from patients for processing

  • assess and prepare sperm samples

  • test the suitability of sperm for use

  • inject eggs with sperm

  • preserve sperm and embryos for future use

  • monitor and maintain the sperm bank

  • monitor embryo development and select embryos for transfer

  • implant viable embryos

  • discuss treatments with patients, explaining success rates and statistics

  • research infertility solutions with other medical, nursing and counselling staff

  • use assisted reproductive technologies (ART) and in vitro fertilisation (IVF) techniques for help with infertility

  • use specialised technical equipment

  • ensurensure regular maintenance of equipment.


Megan Dufton: Embryologist
https://youtu.be/PWUi_VO2JMA

 

 

Working conditions

Embryologists often work irregular hours, including early mornings, evenings, weekends and public holidays. Part-time or flexible hours are usually available.

Embryologists usually work in positions involving either clinical practice or fertility research, in fertility clinics, hospitals and research laboratories. When you are working in a laboratory, you would wear a hat and mask, and work in controlled conditions, in close proximity to colleagues.



Education and training/entrance requirements

To become an embryologist, you usually have to obtain a bachelor's degree in biological science or biomedicine at university, followed by a master's or postgraduate qualification in a relevant field such as reproductive science or clinical science. To get into bachelor's courses you usually require a senior secondary school certificate or equivalent.

Entry into this field is very competitive.

Additional Information

Students and graduates may be eligible for membership with the Fertility Society of Australia (FSA) and with the Scientists in Reproductive Technologies (SIRT) sub-group. SIRT is a special interest group representing the scientific membership of FSA. They promote the education and training of scientists working in reproductive technologies.


Employment Opportunities

Demand for embryologists is expected to grow moderately with the increase in the use of assisted reproductive techniques.

This is a specialised occupation, so while the actual number of roles available is quite small, qualified embryologists should be able to readily find employment in larger population centres.

Once you are employed you will receive on-the-job training in protocols.

There are fertility clinics located nationwide in capital cities and larger regional centres.

Did You Know?


A Day in the Life of Embryologist - Lydia Ruddick CAMEO

This information was taken directly from Manchester Fertility

Lydia Ruddick

Lydia Ruddick, Senior Embryologist

With qualifications in Genetics and Assisted Reproduction Technology, Lydia trained to be a Clinical Embryologist in Birmingham.

With research experience in early embryo development at the French National Research Institute and clinical practice observation in Australia, she brings her wide-ranging expertise to Manchester Fertility to help give you the best chance of a baby.

My Day starts at 6.30am

My day starts at 6:30am with coffee and breakfast, then a quick dog walk. I usually cycle into work and change into my scrubs ready to open up the lab for 8am. We start the day by checking the temperatures of all our equipment and making sure that everything is ready for us to handle eggs and embryos safely.

My first task is to check the eggs from the day before to see if they have fertilised. The embryos are in our time-lapse incubators, the EmbryoScopes. So I can to review an overnight video of each embryos while they remain safe in their stable environment inside the incubator. I then phone the patients to give them details of how many embryos they have and answer any important questions.

Once this is done I check the embryos for that day’s embryo transfer, again using the EmbryoScope. For day 5 embryos (blastocysts) we assess the size and then assign a grade for each part of the blastocyst based on their appearance. The EmbryoScope also generates a score, and allows us to review each embryo’s whole period of development for any unusual behaviour. It feels very special being able to watch from the first signs of fertilisation through to blastocyst formation, contemplating how something so tiny can have so much potential.

Once I’ve graded the embryos and chosen which are suitable for transfer and cryopreservation (freezing), I will contact each patient to confirm details for their transfer. I then use a pipette to carefully move the chosen embryo into a new dish containing EmbryoGlue. (EmbryoGlue is not an actual glue, but it acts like glue by increasing the chance of implantation of the embryo to the womb).

At 11:00am

It’s time for the embryo transfer. This is one of my favourite procedures as it’s an exciting time; after five days of waiting (and of course often months or years before that) the patient can see their embryo for the first time. I’ve heard some nice embryo nicknames, and lots of jokes from patients that their embryos look like their dads.

The doctor and I use our electronic witnessing system to confirm we have both checked the correct dish is ready. As well as our manual checks, every dish in the laboratory is electronically tagged, so the system would alarm and stop any potential error at any stage. When the patient and doctor are ready I load the embryo into a fine plastic catheter and quickly hand it to the doctor, ensuring it spends minimum time exposed to room temperature. After a minute or so the embryo has been replaced into the patient’s uterus and I perform a final check that the catheter is clear.

Meanwhile my colleagues have been performing egg collections, preparing frozen embryos for transfer, and preparing the partner and donor sperm samples for treatments. The lab can feel quite busy in the mornings, especially because some procedures like egg freezing are really time critical. Luckily, I have a great group of colleagues. We’re all really close and have lots of strategies for working effectively as a team and ensuring everything runs to time, something I definitely appreciate on busy days.

At 12:00 noon

In the afternoon our jobs include Intracytoplasmic Sperm Injection (ICSI). This involves injecting a single sperm into each mature egg. We’ll also rapidly cool suitable embryos, a process known as vitrification, and load them on to a tiny plastic device for storage in liquid nitrogen.

We have regular case meetings, visiting speakers and journal clubs, ensuring we’re aware of any new developments in the field that can further help our patients. There’s often news of positive pregnancy tests or baby photos being shared around. There’s a brilliant sense of shared celebration hearing these updates after all our hard work and you can really see the love everyone has for their job - we are one big team.

We’ll also catch up on our own side projects and any patient call requests and messages through our Salve app. Although we can’t always come to the phone immediately we’re always happy to make time to discuss a patient's embryos.

By 4pm

We’re closing up the laboratory, making sure everything is clean and performing all of the temperature checks again ready for another busy day.

End of Day

At home I try to get outside as much as possible to unwind; running, growing vegetables, camping with friends and hiking with my girlfriend and our puppy. I do find myself thinking about certain cases, especially if someone only has a small number of embryos or has had a particularly difficult fertility journey. But hearing positive news from patients and knowing I had even a small part in that is the best feeling, I can’t imagine doing anything else.


 

Neonatal Nurse
Community and Health

Clerical or OrganisingHelping or advisingAnalytic or ScientificSkill Level 5Skill Level 6

Most neonatal nurses work in units called neonatal intensive care units (NICU). These professionals provide care and support during the first month of a newborn's. They particularly monitor babies that require special medical attention. The level of care they provide to newborns depends on their needs, and each state and territory in Australia maintains its own tier system for NICU classifications. Typically, healthy newborns receive care at the first level, while those who require specialised care for illness or congenital disabilities receive higher levels of care.

A neonatal nurse is a registered nurse (RN) who specialises in providing supportive health care to newborn infants up to four-weeks-old. Neonatal nursing involves caring for infants born with a variety of problems ranging from prematurity, birth defects, infection, cardiac malformations, and surgical problems. The neonatal period is defined as the first month of an infant’s life; however, some newborns may require ongoing care. Future Growth Very Strong

Neonatal intensive care nurses help provide various levels of care and support to newborn babies and their families. They care for healthy babies and those with health challenges.

A neonatal nurse’s role involves varying aspects, such as clinical, educational, managerial and research. You will find a neonatal nurse typically in a neonatal intensive care unit, nursery, baby care unit, postnatal ward, emergency room, or even amongst the community.

Caring for newborn infants can be one of the most rewarding experiences in the nursing profession, but can also be just as heartbreaking.

Neonatal Unit
(Source: Normal Nurse Life)

ANZSCO ID: 254425
   

Alternative names:  Neonatal Intensive Care Nurse, NICU Nurse,

Knowledge, skills and attributes

Neonatal nursing is a very challenging profession. It is a technical job which requires a lot of monitoring and administering complex treatment, as well specialised care for neonates with serious and complicated medical issues. Dedication and high resilience, are must-have qualities to successfully confront these challenges and to maintain a long career.

Moreover, one of the most challenging roles of a neonatal nurse involves providing end-of-life care to the unwell baby and providing support to the grieving family. Emotional strength is necessary when facing this aspect of the job.


NICU Nurse at work
(Source: Women's and Children's Hospital SA)

 

Duties and Tasks

Neonatal nurses perform a number of tasks with newborns including providing general care, administering treatment, performing tests, documenting patient history and operating specialised equipment. Their duties may also include:

  • preparing and checking medications

  • managing a baby’s fluids

  • recording observations and documenting a baby’s care

  • initiating appropriate basic resuscitation in an emergency situation

  • educating and supporting parents

Basic neonatal care
    

Neonatal nurses care for newborns beginning immediately after birth. Some common duties for primary neonatal care include:

  • weighing and measuring the baby upon birth

  • bathing

  • monitoring the health of the newborn

  • providing support to the medical team and family

  • educating new parents about newborn care and breastfeeding - educating families about caring for their newborns

  • communicating with the newborn's doctors, nurse practitioners, physician assistants, nutritionists and surgeons

  • providing basic care, including frequent diaper changes, skin care needs and positioning

  • giving medications as prescribed for the newborn's condition

What to expect
(Source: Raising Children)

Advanced neonatal care
   

Besides providing basic newborn care, neonatal nurses provide advanced care to babies who require extra medical attention. Neonatal nurses may work with newborns with a variety of health concerns such as:

  • issues related to premature birth

  • congenital defects, such as heart issues

  • chronic health conditions, such as genetic disorders

  • surgical issues and other body malformations, such as a cleft palate


Working conditions

A neonatal nurse's shift is similar to that of other RNs. RNs usually work 12-hour shifts in the hospital or 13 shifts a month. Depending on where you work and the level of care you provide, a neonatal nurse may work:

eight-hour shifts
nights
evenings
weekends
holidays

Neonatal nurses typically work in hospital settings within:

labour and delivery
postpartum maternity
paediatrics
NICU

Some neonatal nurses also work in:

physician's offices
birthing centres
healthcare clinics

Neonatal nurses often work in stressful environments, where they remain calm and provide support and care to newborns and their families. It's important for neonatal nurses to be quick problem-solvers who work well under pressure and have excellent communication skills.

 

Additional Information

Being a nurse exposes you to all types of emotions on a daily basis especially when working in an intensive care unit. Sudden changes or health deterioration can take place quickly and emotions can be subject to extreme highs and lows. Along with these emotional challenges, you have to provide special and often complex nursing care to an unwell baby while also providing support to the family.


Education and training/entrance requirements

To become a neonatal nurse, you must first be a registered nurse (RN) and/or midwife, both of which require the completion of a Bachelor of Nursing & Midwifery. As a graduate you may then have the opportunity to be placed within a neonatal ICU (NISU) or specialised nursery unit.

It is not essential for a neonatal nurse to possess a postgraduate qualification in the neonatal area, but it is often preferred by many employers. This may include a Graduate Certificate or Master’s level qualification in the specialised field, which will involve some mandatory placement. To gain entry to one of these courses, many education providers will require you to have some experience in neonatal before being admitted to the program.

There are also other certifications and short courses that be undertaken to develop your career in neonatal nursing.

After you graduate with your bachelor's degree, register with the Australian Health Practitioner Regulation Agency (AHPRA) to become an RN. The AHPRA is a governmental regulatory body that oversees the credentials of health care professionals. The agency requires all nurses to apply for registration before practising and to renew their registration each year.


Employment Opportunities

Nurses and midwives, in general, are highly in demand in Australia. Neonatal nurses can work in various settings, in a private or public institution. Depending on your qualifications, both academic and practical, you can choose to work as a practitioner in a hospital, be an educator, participate in research or eventually take up a managerial role.

Did You Know?

The following information is taken directly from Qld Health.

The stories are about three Neonatal Nurses and the NICU at Royal Brisbane Women's Hospital.

RBWH

In hospitals, the Neonatal Intensive Care Unit, or NICU, is a busy micro-world. The staff who run the NICU, a team of round-the-clock nurses and doctors, are highly trained to offer specialist care to the newborn babies and families in their ward.

We spent some time in the Royal Brisbane Women’s Hospital NICU ward with nurses Haley, Beth and Sarah, learning what life is like inside the NICU and what it takes to be a NICU nurse.

NICU Nurses
NICU Neonatal nurses (from left) Haley, Sarah and Beth attending to baby Henry.


What is NICU?
A Neonatal Intensive Care Unit provides care for newborn babies that are very unwell. Often, these babies have been born prematurely, with some babies born as early as 23 weeks gestation. Full-term babies – babies who have been born around their expected due date – might also be placed in the NICU when they are born if they are very unwell.

Like an Intensive Care Unit for adults, the NICU is reserved for the sickest patients. “Sometimes people don’t realise it’s an Intensive Care Unit,” says Haley. “It’s not a normal ward for babies. They are receiving very high care.”

Some babies will require ventilation, which means a machine helps them to breathe through a tube down their throat, because their lungs aren’t fully developed. Most will also have different tubes and monitors attached to their bodies to help them feed, receive medicine and monitor their health.

As the babies gradually grow and get healthier, they can be moved to the Special Care Nursery of the hospital to receive ongoing care. Eventually they are released to go home with their families. Despite the best efforts of the team, some babies don’t respond to the medical care they receive in NICU, and the decision may be made to withdraw their care and provide palliative care instead.


Life inside the NICU
  

The NICU at RBWH is separated into a series of rooms, each containing six cribs. There can be up to 28 babies in the NICU, many who will stay for over 100 days until they are well and strong enough to move to Special Care and eventually go home.

The NICU is a busy place. Each NICU room is allocated a set of nursing staff, who look after one or two babies each throughout their shift. The nurses work with doctors and other allied health professionals to provide 24-hour care for the babies and their families. At any one time, there can be three nurses in a NICU room, a Neonatal Education Support Team (NEST) staff member who helps them with their work, doctors, other health professionals, and parents and families visiting their babies.

Nurses admin
Neonatal nurse Haley enters patient observations and other details into a patient’s chart.


The NICU is not the type of environment new parents would typically dream of for their baby’s first home. Large cribs dwarf the babies they contain, who lie inside tiny and fragile, fighting for life. Bright fluoro lights line the roof so staff can see clearly when doing detailed work on their small patients. The air smells of the hand sanitiser that is constantly used to rid staff and visitors of infectious germs, and the monitors and machines beside each crib beep and flash to give second-by-second updates on the babies’ health.

Where possible, small details are put in place to make the NICU more homely. Rooms of the RBWH NICU are decorated with an ‘under the sea’ theme, and brightly painted dolphins, turtles, seahorses and fish splash, dive and swim along the walls. While the babies don’t wear typical baby clothes, in their cribs are pillows and blankets covered in colourful children’s fabric.

The NICU isn’t filled with the cries and coos of babies you would expect from most nurseries. Some of the ventilated babies aren’t able to make sounds around their breathing tubes, and because they have been born prematurely or are unwell, most NICU babies also spend a lot of time asleep. “They’re using a lot of energy,” Beth explains. “They’re learning to move in a different environment, learning to breathe and to eat – it’s exhausting for them, so they sleep a lot of the time.”

But, Beth says, the babies still behave like babies. “Like any baby, they do let you know when they need a nappy change!” she says.

Working to routine
   

The NICU revolves around routines. Nurse shifts can be either 8 or 12 hours, and a detailed chart updates them on where each baby is at when they start their shift.

Each baby is fed every couple of hours, and a large fridge sits outside the room with containers of mums’ breastmilk labelled for each baby, as well as donated milk supplies from the Milk Bank. Other regular forms of care include changing the babies’ nappies and turning their heads to rest on alternate sides.

Sarah says that people often think that NICU nurses spend their days holding babies, but in reality, they don’t touch the babies that often. “We turn the babies over every six hours. We try not to touch them too much, because it makes them uncomfortable,” she explains.

Cuddles are reserved for parents, though it can take a long time for some babies to be well enough to be held out of their crib. One mother is visiting her 10-week-old baby, born at 24 weeks, who she has only been able to hold twice. Instead of cuddles, she places her finger in his little hand and holds his head, soothing actions NICU teams called ‘hand cuddles’ that are beneficial for both child and parent.

There are some routines that vary for each patient. The babies may be prescribed medications that need to be given regularly. Some of the babies require frequent tests to monitor things like the levels of carbon dioxide in their breath, which gives an indication of their health. The nurses might also use charts to record the outputs of the monitors that track the babies’ vital signs and the work of their ventilators.

Some tasks only happen as needed. When one of the babies needs an x-ray, a medical imaging team come to the ward with a portable x-ray machine that they can use to complete her scan without moving her from her crib. One baby requires the tape securing her breathing tube to be replaced, as saliva and fluids have made it come unstuck. Two of the nurses are required to do this delicate task, as the tube must stay in place so that the baby continues to breath while the securing tape is changed.

NICU Nurses
NICU Nurses Haley and Sarah replace the respiratory and feeding tubes for a patient, which is delicate and fine work performed through the hand access points in the crib.

Whole-of-family care
   

While the babies are their first priority, the nurses also provide support and care to their patients’ families. Having their baby stay in NICU is usually unexpected for parents and not part of the journey they had envisioned when planning a pregnancy and birth.

“I do the best I can to support families,” says Beth. “This work makes you appreciate how short life is, and how the impact of an experience like this can carry on over an entire lifetime. Their relationships can suffer, and it’s good for them to have someone to be able to listen to how they feel and say, ‘That’s normal’.”

The nurses provide emotional support for the parents and families, help them understand their baby’s condition and medical care, and refer them to support services like counsellors and social workers when needed.

Because NICU babies might stay in hospital for many months, visiting them in hospital can be difficult. Some parents need to go back to work after they’ve run out of available leave, and many don’t live close, meaning they might not be able to visit their babies as often as they want.

When a baby’s family isn’t able to visit often; because they live far away, have to work or have other children to care for, the nurses keep them up-to-date with regular phone calls, so they still feel connected to their child.

“You don’t just look after the babies, you’re looking after the families here and at home, too,” says Haley.

“They’re all amazing,” says one mum, who has driven to Brisbane from Warwick to visit her baby. “They keep me from going crazy and make sure I always know what’s going on and understand everything. They provide a listening ear and a shoulder to cry on when I need it.”

With parent
Beth with mother Morgan and baby Henry.

What is it like to be a NICU nurse?
   

When Sarah started her general nursing training, she didn’t know that NICU existed.

“I did six months in the Special Care Nursery during my training, and I discovered NICU during that time,” she says. “From the outside, you don’t really know NICU exists.”

She’s now worked in NICU for five years and says she enjoys the family care aspect of her job. “I love looking after the families and meeting people through my work.”

Haley has been working in NICU for 10 years, and is now part of the NEST program, which means she supports new NICU nurses as they do their work, and is on the ward to help out if anyone has questions or needs an extra set of hands.

“The best bits for me are watching the parents when they get to experience those normal milestones for the first time, like getting to bath their baby or getting to hold them,” says Haley. “Of course, seeing them spend so much time here and then finally get to go home is amazing.”

Beth echoes this sentiment. “That rush of emotions for parents when we’re getting them out the door is overwhelming,” she says.

This is Beth’s tenth year in NICU, and her fortieth in nursing, having spent her earlier career in paediatrics. “In nursing, you know when you’re in the right place,” she says, “and I’m in the right place. I find babies less difficult than adults – babies are what they are, they don’t have any other agendas. I’m getting to the end of my career and I can honestly say I’ve never wanted to do anything else.”

Like all nursing roles, there are also difficult parts of the job for the NICU nurses.

“Not all of our babies make it,” says Sarah. “Everyone gets affected by that in different ways.”

“The hardest part is end of life,” agrees Haley. “Having to watch the parents go through that is very difficult.”

Leaving work at work can be difficult. Time spent in the NICU can be tense, especially if a baby isn’t doing well.

“The babies are so little,” says Beth. “When they go downhill, they can go downhill really fast.”

“The hardest part is self-care,” she says. “There’s constant grief and loss. Not just if a baby passes, but of the whole experience. Mums and dads lose the experience they thought they were going to have. You have empathy and sympathy, but you also have to draw the line for yourself.

“On my days off, I’m an outside person. I get out in nature, go to the ocean, and remind myself that I’m a small cog in the machine; I don’t have to be responsible for the whole outcome.”

Even though there are challenging days, the nurses relish the opportunity to work with their NICU babies and families.

“The babies teach us so much,” says Beth. “Their fortitude, their will to keep going. They are my proof that here, miracles do happen.”

Baby sleeping
A premature baby's job is to recover, strengthen and grow through sleep.
(Source: Qld Health)

 

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Material sourced from
Jobs & Skills WA [Obstetrician; ]
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Indeed [Neonatal Nurse; ]
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