My first week at the hospital was spent mostly shadowing and getting to know the unit and their practices, and it has already exceeded my expectations. I’ve mostly been spending my time rounding with the attendings and residents, and even though I can’t understand much of what they discuss because they round mostly in Finnish or Swedish, I can already tell the difference in the care here. Much of this difference has to do with a culture of trust.
One of my first observations was that the parents are nearly always present during rounds (and at other points of the day), and they don’t appear frazzled or stressed to be there. This is quite different from the parents that I’ve observed at home, many of whom have either slept poorly in a chair at the bedside or have woken up very early to make it to the hospital before the doctors begin discussing their baby. Here, many of the parents sleep in a hospital bed next to their infant and are able to shower, cook, and do laundry in the parent facilities just down the hall. This, to say the least, allows the parents to be present at rounds, but also provides some much needed normalcy to this very hectic time in their lives.
I shadowed a nurse for a day, following just one mother and baby. This mother, like many of the other mothers and fathers in the unit, stays every night in the unit and is extremely involved in her infant’s day to day care. She is provided opportunities to participate in nearly everything–from changing diapers and picking out clothes to holding/kangarooing her infant and filling the feeding tube with her milk. She and her infant were always first encourage to attempt breastfeeding before her expressed breastmilk was put through her infant’s feeding tube, and even then the milk that the baby received was usually unfortified, unrefrigerated breastmilk. This is an important distinction to make because breastmilk looses some of its benefits when it is refrigerated/frozen, pasteurized, or fortified. We scientifically understand this nutritional difference, but U.S. policies don’t allow for the same flexibility of breastmilk use as exists here.
One of the most amazing things I’ve seen has occurred during conversations between parents and physicians on rounds. The first thing the physicians do when rounding is ask the parents what they think about their infant’s health. We say we do this in the U.S., but I’ve seen rounds where parents are an afterthought, only being asked once labs and prescriptions are ordered and the team is on its way to the next baby. Even when we do ask at home, I’ve always felt that parents aren’t really sharing their true thoughts, but are instead saying what they think the physicians want to hear. Here in Finland, the families already feel supported by the NICU staff in so many ways that they aren’t afraid to share what they think. They know the physicians genuinely want to hear from them because, while they may not have much medical knowledge, they do have an instinctive understanding of their baby. These instincts exist partially because they are genetically related to the infant, but also because the physicians trust them to get to know their infant extremely well by providing direct care.
Although I knew the NICU here was very advanced in its family-centered care and support of breastfeeding, I am still stunned that it can actually exist. The inherent trust that exists between families and clinicians here makes a world of difference. When we trust that parents know what is best for their infants and are motivated to take action on that, then physicians and nurses can spend their time practicing medicine for the infant instead of trying to exert control over the family.