Respectful Care in the NICU: Take Two

Racial and ethnic disparities continue to impact prematurity across the nation. The National Perinatal Information Center provides stratified race and ethnicity reporting for our member hospitals for both maternal and newborn outcomes.

Posted under: Other, Quality of Care

Last year, NPIC posted a blog about Respectful Care in the NICU, and how to apply the concepts that shape Respectful Maternity Care in the NICU setting. We are going to use some of that here, but there is more to do.

The Centers for Disease Control (CDC) reported that in 2022, 10% of babies were born prematurely, which was a slight decline from 2021. However, in 2022, the rate of preterm birth among African-American women (14.6%) was about 50 percent higher than the rate of preterm birth among white or Hispanic women (9.4% and 10.1% respectively).

Racial and ethnic disparities continue to impact prematurity across the nation. The National Perinatal Information Center provides stratified race and ethnicity reporting for our member hospitals for both maternal and newborn outcomes. In 2022, NPIC reported 312,840 neonatal discharges within the NPIC Perinatal Database. Of those discharges, Black newborns had the highest average length of stay (ALOS, 5.83 days vs White 4.22), highest APR DRG case mix index (CMI, 0.7479 vs White 0.4615), and the highest utilization of Medicaid (60.5% vs White 29.2%). Recognizing the real disparities and how to impact access to high quality, unbiased, and respectful care in the obstetric and NICU setting is critical to health and birth equity.

On September 29, 2023, the CDC released a report on mistreatment in maternal care, Many Women Report Mistreatment During Pregnancy and Delivery:
  • About 20% of women reported mistreatment while receiving maternity care.

  • About 30% of Black, Hispanic, and multiracial women reported mistreatment.

  • Almost half (45%) of women held back from asking questions or sharing concerns during their maternity care.
Now think about your NICU…what would these results look like if the CDC sought to evaluate care and interactions in the NICU?
  • How many women or parents would report mistreatment of their newborn? (“Rough” care, such as non-developmental care movement during diaper changes, daily cares, feedings?).

  • Would these reports be different if you stratified the results by race?

  • How many women or parents hold back questions or sharing concerns regarding their newborn during their stay in the NICU?
According to the CDC. “every mom deserves respectful and responsive care during pregnancy and delivery.”

So, let’s rewrite this for the NICU:
Every baby and their family deserve respectful and responsive care during their NICU journey.

Respectful Care…What is That?
Understanding the value and importance of respectful care in the neonatal care setting is and will be an essential conversation to engage. In pregnancy and obstetrics, Respectful Maternity Care (RMC) is defined as the preservation of a person’s dignity, choices, and preferences during birth and during the postpartum period. Respectful Care has been and continues to be a priority for maternal health outcomes, particularly with the continued disparities that are discussed within communities, including significant maternal and neonatal outcome disparities experienced by Black and Brown women, and other marginalized communities.

While the Respectful Care model typically focuses on the person giving birth, it is essential that these elements are applied to the supportive care of the mother/patient and newborn dyad in the Neonatal Intensive Care Unit. There are a few areas to focus on, including reducing stressors, provision of family navigators and support structures, and trauma-informed care. What are some of the elements of Respectful Newborn Care? Let’s dive in:

Reducing Stressors
The stressors that new parents experience with the birth of a premature newborn can be overwhelming. And supporting a new parent is critical in offering Respectful Newborn Care. Respect for the parent and their needs is an essential element of newborn care.

Imagine you have just given birth 2 months early, and you have two young children at home. Your spouse is ill and not able to visit with you and your newborn. You live an hour away from the hospital, and arranging childcare is uncertain. What is going through your mind? How are you going to be in two places at once?

NICU parents deal with these types of situations every day. Providing support to the mother and family to assure opportunities for bonding and care provision are essential. Transportation, food security, and the care of other dependent children as needed for frequent visitation to the NICU provides stability and a sense of control. Financial challenges compound these issues and further accelerate disparities that are found within neonatal care. Fully understanding social determinants and drivers of health (SDOH) speak to the promotion of dignity, autonomy, and the ability to care for a newborn amid turmoil, such as an unexpected admission to the NICU.

Trauma-Informed Care
Trauma-informed care is an essential principle of the Respectful Care model. Facets of trauma-informed care, such as previous experiences of trauma and subsequent response and reducing the impact of a current trauma (like an unexpected admission to the NICU) provide a meaningful foundation to the care of mothers and families during a stay in the NICU. Maternal/newborn separation can exacerbate trauma, and facilitation of visitation and information is key. Again, identification of environmental and social/structural determinants of health and their mitigation can ease the impact of further trauma to a family unit. These elements are cyclical, and all serve as conduits within a Respectful Care paradigm.

Part of reducing parental trauma in the NICU is assuring a shared decision-making approach for care. Encouraging involvement and supporting choices in the care of a premature baby can be empowering and motivating for a parent experiencing trauma during a NICU admission.

We’ve got this. We’ve all got this. Together, we can create intentional, meaningful and respectful environments for our babies, our moms, patients, families, and communities.

Learn more about Prematurity Awareness Month.
Interested in data that can support prematurity research? Connect with National Perinatal Information Center about research access to the NPIC Perinatal Database. NPIC has one of the oldest and most robust and dedicated linked mother/baby datasets in the US and provides key metrics for linked maternal and neonatal outcomes. To learn more, contact
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