When I started out in the neonatal unit at the Erinville maternity hospital in Cork almost 35 years ago, I was petrified.
Unlike adults, babies were not able to tell you what was wrong with them, or so I thought.
I wasn’t long learning that even the tiniest ones who weigh less than a pound are well able to tell you in their own way what they want and don’t want. They are just amazing.
I started my general nurse training in Waterford on November 3rd, 1975, and went on to Kirkcaldy in Fife, Edinburgh, to train as a midwife. My mother applied for a job for me in the Erinville while I was in Edinburgh, and I started work there on April 16th, 1980.
The one place I did not want to work when I started in the Erinville was the neonatal unit, but that is where the matron put me. I was terrified for the first two years before I gained confidence in what I was doing, and I have never worked anywhere else since.
My mentor and trainer there at the time was a very experienced sister called Mary O’Brien, who went on to become matron of the Erinville.
She was one of the most experienced neonatal nurses in the country at the time. She trained everyone, from junior doctors who later became consultants to nurses, including myself, instilling confidence and a love of neonatology in us all.
In 2007, after I had worked for 27 years in the Erinville, the three maternity hospitals in Cork were amalgamated into one big unit at Cork University Maternity Hospital. The neonatal unit at CUMH seemed so much bigger than the unit in the Erinville, which was small and often very crowded but everybody knew each other very well there.
The unit in CUMH is divided into two sections, intensive care and special care. We cater for all sick newborn babies born in Cork as well as sick infants who require specialist treatments such as cooling, nitric oxide (a chemical compound used to treat infants with severe breathing problems) and specialised types of ventilation, from the surrounding catchment areas of Tralee, Limerick and Clonmel.
Research has shown that cooling babies down to approximately 33 degrees for 72 hours after birth can reduce the risk of brain injury and disabilities such as cerebral palsy.
Twins, triplets and quads
Since fertility treatment started growing in popularity, we have often had two or three sets of triplets in the unit at the one time. Two months ago, we had eight sets of twins and two sets of triplets. I remember in 1980 we had a set of triplets born in the Erinville and it was so rare that everybody in the hospital came down to neonatal to see them. During my time there, I also cared for two sets of quads; thankfully, they all survived.
Our really sick and premature babies go straight to the intensive care area and are moved into special care once they begin to improve. Some of the sickest babies spend several months with us.
The smallest baby I have ever cared for was 445 grammes, lighter than a pound of sugar. He’s about 10 now and running around the place. I have also cared for tiny premature infants, some of whom returned to visit on special occasions such as birthdays and later Confirmations, and even a wedding.
The very small babies are put on a ventilator after birth, which helps their breathing. Once they begin breathing for themselves, they are transferred to a continuous positive airway pressure (CPAP) machine which delivers the exact amount of oxygen they need. All of this care is continually recorded by monitors which are attached to the infants.
Breathing and feeding issues
The two hardest things to deal with in tiny babies are breathing problems and feeding problems.
This is because their lungs and intestinal systems, even though perfectly formed, are very immature and premature infants can have a challenging time until feeding is properly established.
On a typical day, I start work at 8am and finish officially at 8.30pm, although I am often still there after 10.30pm. We look after the babies first and catch up with our paperwork in the evening.
As a ward manager, once I come on duty I get a handover on activity in the unit. This includes the number of infants, all new infants who may have been admitted and any problems that might have occurred on the previous shift. This might include a list of to-do jobs, emailing for services, ordering stores, requesting maintenance and so on.
I check that the nursing staff coming on duty are allocated to care for infants and that they are aware of any issues that may present. I must also check that new nursing staff or students are appropriately mentored. We have a lot of students coming to the unit, including nursing, medical and ambulance trainees.
I may also have a caseload myself, depending on the number of babies in the unit.
Once I have established that the immediate tasks are sorted, I prepare for medical neonatal rounds. I accompany the doctors on their rounds and record all the requests and orders they make in the infants’ notes. The doctors always make time to speak to parents on the rounds.
All the time I am on duty, I keep a constant watch on what is happening in each of the areas, offering advice to staff and parents.
If an infant is being prepared for home or for transfer to another unit, I have to liaise with the postnatal ward, delivery suite, public health department or another hospital.
Traumatic experience for parents
Having a sick or premature baby in the neonatal intensive care unit (NICU) can be a scary and traumatic experience for parents. Many parents have never heard of NICU, even if they have other children, so it can be quite a shock when they find themselves and their baby here. Some parents know in advance that their baby will spend time in the unit.
The RTÉ programme about the unit, From Here to Maternity, which was broadcast in 2011, definitely gave parents a better understanding of what goes on in NICU. I always tell parents to ring in if they are worried about anything after they get home, and many of them do.
What makes this job worthwhile is when parents come back to visit us with happy, healthy babies who were really small and really sick. Lots of people stay in touch and send us photos and cards.
One mother came in last week on her baby’s first birthday with her beautiful baby and a cake.
Out of hours Despite being married to a farmer for 31 years, what I know about farming could be written on a postage stamp. I am a mother of five. My youngest is 21 now and studying in UCC and my eldest is 30.
I love to sew and make most of my own clothes; it’s my hobby. Our house overlooks Courtmacsherry Bay in west Cork and I love to walk by the sea. I also enjoy my daily fix of The Irish Times crossword.
