Story of Merge: Episode 2

Picture this. You are halfway through your shift and already your team has attended three births of babies less than 28 weeks gestation. The most recent birth is a 26-week girl born by emergency caesarean section to a mother with a placental abruption due to a motor vehicle collision. The neonatal care team accompanies the transport incubator to the neonatal intensive care unit (NICU). As neonatal care professionals, we are accustomed to how the neonatal care team works to provide life-saving care. Neonatal care professionals know that most preterm babies born at 26 weeks will survive, most without serious morbidities. Most parents do not!

Marginalized and alone because the birthing parent is still in the post-operative recovery room, the father of this baby follows the transport incubator at a distance. He is bewildered and in shock, unsure if his tiny daughter will survive. He looks to the healthcare team for answers, but they are too focused on providing life-saving care to realize he is standing there, feeling terrified and abandoned.

Each year about one in ten babies are born preterm. Globally, that means about 13 million babies. With increasing rates of preterm birth, NICUs do not have enough beds or staff, and hospitals exceed budgets. What if all neonatal care professionals could make space for terrified parents of critically ill babies? What if babies could go home sooner and prevent hospital cost over-runs? Merge can train neonatal care professionals to do that.

Globally, there are multiple models of family centred care for neonatal intensive care units with great diversity in how the models are implemented and sustained. Some models focus on level III NICUs; some focus on psychological supports for parents; some include peer mentorship for parents; some use face-to-face, train-the-trainer models; some use asynchronous online modules; some take 18 months to complete the training; and some use digital education and data collection platforms for parents. Regardless of the diversity, the overarching purpose of each model is to improve the quality of family centred care and outcomes for the baby and parents; and only one model considers improving health system outcomes. After considering multiple models, we brought the world-renowned team from Mount Sinai Hospital in Ontario to train neonatal care professionals for our clinical trial. After 1.5 days of face-to-face training, neonatal care professionals in our jurisdiction asked, “What do you want us to do with that training?” At that moment, we realized that we needed to rebuild a family-centred care model that met the needs of neonatal care professionals. The rebuilt model focused on communications with tools and strategies to support neonatal care professionals to implement family-centred care practices. The question became, “Will this new model improve outcomes for babies and parents, and reduce costs?”