The reality of the NICU

People ask all the time about what it’s like in the NICU. They say “it must be so hard,” “it must be so scary.” And that’s true, to some degree. It is hard, and it scary. And it’s so much more. The truth is that the NICU is an intense, beautiful, complicated world. 

First off, for those of you who don’t know, the NICU stands for neonatal intensive care unit, and it’s the hospital unit where babies go when they need extra medical care. There are a vast assortment reasons for babies to be in the NICU – some babies just need a few days of TLC before they’re ready to go home, while others are clinging to life. Some are premature, some are full term. Some families know in advance they'll need the care of the NICU, but for most families it's a stressful, unexpected experience.

When I try to describe what the NICU is really like, it usually goes something like this:

preemie baby on cpap in incubator in NICU

The NICU is hard. No doubt about it, it’s hard. It’s hard to see babies struggling to live. It’s hard to see babies separated from their moms and dads. It’s hard to see families worried – terribly worried - about their babies. It’s hard to see parents trying to understand complex medical diagnoses and having to make impossible choices. And yet...It’s wonderful. To see a person - a very tiny but very real person - grow from a fragile, delicate 1 pound baby to 2 and then3 and then 4 pounds before your eyes is incredible. To see a 9 pound baby who was covered with tubes and wires, sick, medicated, alone in the crib.... to see those tubes and wires go away over time, and in their place finding parents snuggling them with their sweet milky smiles, it's fantastic. To see families adapting to meet the needs of their babies, and see them gain confidence as they learn and grow is lovely. And to see the postcards and holiday cards showcasing strong little former-NICU patients starting kindergarden, graduating college, raising their own families? Absolutely beautiful.

The NICU is scary. NICU’s are filled with equipment so big - for patients so tiny - that you can’t even see the babies through it all. Weird blue lights and plexiglass incubators, resuscitation bags and IV’s and monitors at every bedside. You have to sterilize yourself before entering, and it looks like nowhere you’ve been before. Many NICUs try to make it cheerful with cute prints and happy colors, but it’s basically filled with so many complex machines and un-baby-like equipment that it’s intimidating to the newcomer. And yes, it’s ok to admit it, the babies can look scary too. All of the babies have monitor wires or feeding tubes or oxygen tubes, all of which are disturbing. Babies born extremely premature can look more like baby birds or aliens than like babies. Their skin is translucent, their eyes fused. Some full term babies may have disfiguring conditions that are difficult to see. And yet...It’s adorable. Stop by each bed, look past the equipment and look past the diagnosis, and you’ll meet a unique and beautiful new baby, with a personality all their own and a powerful will to live. Look around at the brand new families – loving parents, siblings, grandparents - doing everything they can to trust and learn and love under such intensity. It warms your heart. The tiniest footprints, and the most precious baby smiles all reside here.

The NICU is noisy. Equipment running 24/7, bubbling, beeping, crying babies. Nurses discussing. Doctors and therapists consulting. Alarms. Alarms. Alarms. The never-ending beeps and bings of alarms. It takes years to get used to the NICU noises, so while we nurses are pretty immune to it, newcomers find it overwhelming. And remember this - while chatter and background noise can be annoying, sometimes the alarm ringing means a baby has stopped breathing. When it means that a crew of medical staff need to rush in and save a baby, it’s more than noisy. It’s truly stressful, it's overwhelming. And yet...It’s inspiring. All of the babies are getting incredible care with remarkable technology, which makes their good outcomes – their very survival - possible. And with the advances that continue to be made, outcomes are better than ever. The noises and chaos are part of the process of saving lives.

The NICU is heartbreaking. It’s literally about life and death. Some babies there are relatively healthy and may need a small amount of extra care before going home, and yet some babies, just a few feet away, are struggling mightily to survive. It’s a unique environment where celebrations and tragedies may be happening side by side. It’s a kind of tension unlike any other. Unfortunately, sometimes babies die. Nobody should ever have to experience this. Nobody. Ever. But it happens here, and what are the right words to describe it? Devastating. Crushing. Profound grief. Impossible sadness. Unbearable. It’s so hard to have to be the place of such sadness. Why should some live and others not? Why should some babies have easy courses while others have problem after problem after problem? It's complicated, and just plain unfair. And yet....It restores faith in humanity. It's all about love. And it's about people coming together - families, nurses, doctors, therapists, and so many more - devoting themselves to the care and well being of our future generations and of each other. Step back and see the hugs, the smiles, the shared tears, the whispered prayers, the gratitude, and the hope, and it's hard not to feel inspired. We all are doing everything we can to make a healthy and happy future for these sweet babies. It's good work, and as hard as it is, it's a loving place filled with hope and devotion.

micropreemie baby held by mother in NICU, intubated, black and white

s overwhelming! With all of this, how could it be anything else? It's all of the real world condensed into one small microcosm - babies and families, life and death, rich and poor, celebrations and grief, good and bad, joy and sadness. Nobody ever wants to have their baby there, but all are grateful for the chance at life the NICU offers. Everyone is profoundly changed by the experience – some for the better, some for the worse. Some families move through their journey unscathed, some are crushed by the intensity of the experience, some struggle, rise to the challenge and blossom. And yet....I love the NICU. I’ve been working in NICUs for my entire nursing career, and I can’t imagine any kind of nursing I would rather do. I have never experienced the NICU as a parent, but I am a parent and as such I can appreciate the staggering intensity of parenting in the NICU. I am humbled every day as I witness families come through our scary doors into this weird and intense environment, and they do it for love. They do their very best, and they become participants in this unwelcome journey because of love.

To NICU parents - My hat's off to you. I’m honored to support you along the way, and no matter how you handle it, I understand the enormity of the struggle and appreciate that you’re doing your best in the hardest of experiences.

What would you add? 

What is the reality of the NICU to YOU?

This article was originally posted July 28, 2014, and was migrated to new website/blog on Nov 17, 2020; 

all comments from original post are dated with today's date rather than the original comment date. Photos republished with permission.

Trish Ringley is the founder and CEO of Every Tiny Thing. She has been a NICU nurse since 1997, and she's been creating the products and accessories that NICU parents love since 2014. When she's not at work caring for NICU families, she's raising her two teenage kids, gardening, and raising service dog puppies for Canine Companions for Independence.


  • Samantha

    My son has been in the NICU for almost a month now, since he was born at 27+2.
    The NICU is a dreadful place, where all of your instincts as a mom are beeping like those terrifying alarms, telling you THIS ISN’T RIGHT! Your baby shouldn’t be so skinny, he shouldn’t be struggling, he shouldn’t be outside of you, he shouldn’t be away from you. It’s hard to shake that feeling that everything is very wrong, and some days it makes it hard for me to visit because I don’t want to face all of those internal alarms along with the constant beeping.
    The NICU is a miraculous place. Our baby is just over 1 kg now, and he’s been earth-side for almost a month. He’s alive and he’s been full of personality since day one! My tiny son is amazing, and it’s a privilege to watch him live and grow and blink at the bright world of the NICU, the only world he knows. A world that has allowed him to live!
    The NICU is a scary place. That phone call that I got only an hour after I was there with him, telling me that even though he’d been doing well, he now needed to be reintubated and then upgraded to a more intense ventilator; or the way that his sleepiness suddenly turned from a positive thing—“he needs plenty of rest”—to a sign of infection—“he’s grey and lethargic;” keep me on my toes, always aware that even when things are on the up, there could be a new complication hiding around the corner, ready to terrify us or worse.
    The NICU is the most joyful place I’ve ever visited… because my little boy lives there. I get to place my hand on his head and on his little body and watch his expression as long as I want, sometimes until I almost have bruises on my arms from leaning on the side of the isolette, sometimes until he starts desat-ing and they say it’s best to leave him alone. I get to watch him blow spit bubbles and kick up his tiny legs in protest of a diaper change. He opens his big little eyes for me when he hears me talk and we stare at each other in the moments between his eyes wandering because those muscles are so new. When those big little eyes meet mine I know I’m looking at the most precious person in the world.
    The NICU is both a get-me-out-of-here and I-can’t-stay-away-from-here kind of place. I hate going and I hate leaving and I can’t wait for it to be done. Sometimes, though, when my son’s tiny hand has crept up in his swaddle to grip my finger, I’m certain that we’re right where we need to be.

  • Dawn

    Like you, I walked out of nursing school and into the ICN—been here for nearly 26 years and I will never go elsewhere. It’s all that you describe and more. It’s exciting and nerve wracking every day and filled with wonder. I’m taking care of a 1 and half pounder and a big 9 pound bruiser right now—such extremes. I have always thought of the nursery as a microcosm of the rest of the hospital; cardiac patients, sepsis, preemies, unusual anomolies, and high biliruben babies all right together. You learn something new every day and it keeps you fresh and alive.

  • allie

    My son was in the NICU for a week. He was 8# 6oz and past due. He tore his lung with his first breath and had ecoli sepsis. He came c-section after i spiked a fever they couldn’t drop and both of our heart rates had spiked. He was in the 200s and mine was in the 120s. As soon as he was born he was wisked to the NICU. I was able to see him a couple hours later and the staff had made room for my gurney to be wheeled in next to his isolet and they let me hold him for the first time. The NICU was a floor below my room and the nurses called me everytime he woke up so i could come down and feed him. The nurses were so great in making it to where I could be with my son as much as possible. They did everything to help me be comfortable because I was still sick. They even lowered the room temperature so I could stay with him. The nurses were so great and always had him all set up and ready to nurse when I came down. I felt bad because he was so much larger than most of the babies and was relatively healthy while he was in the NICU. He was usually between babies weighing 1 or 2 pounds. They had their own personalities. They were little fighters. I felt my son acted as a little mascot for them. Giving them something to fight for. One was born at 27 weeks and he was a fighter. He would be fist pumping in his isolet. He would even fight the respritory therapist as he was progressed from the vent to cpap to just the nasal canula. It was inspiring to see such a little guy fight so hard. I respect all NICU staff because they fight so hard for these little guys. My son is a healthy 11 month old and has had no health problems since. I am so greatful for the NICU staff for taking such great care of him.

  • nancy

    This article is very close to home for me. My twins were born at 30 weeks, 1 needed a lot of care and 1 that only needed the c-pap. The NICU staff were amazing. Being in the NICU is hard and you really never know what to expect, everything can change so quickly. While reading I noticed that the author stated that they were honored to he support us as parents, however I believe that we as parents should be honored to have you in our child’s lives. I believe that you as nurses are there for our babies when we can’t, you change their bums, you talk to them, and in some cases you are there to snuggle them. Having other children at home i needed to be home at night for them and if it was not for the NICU team I would not have felt as comfortable to leave my beautiful girls in their hands overnight.

    Thank you to all the NICU nurses that make our journeys through the NICU just a little easier!!

  • Chris DeGray

    I am a grandmother of a beautiful granddaughter that spent her first 110 days of life in the NICU. It was a VERY bumpy road for sure and was also awsome to watch her grow in front of us. There aren’t enough words to say about the caring and wonderful staff she had. We are so great full and blessed.♡♡♡♡

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