‘A lot more joy than sadness’ in neonatal care

June 1, 2021

Learning she had twin older brothers who died as premature babies helped Helen Barwick commit to a nursing career in neonates.

Waikato neonatal nurse Helen Barwick wanted to be a nurse from a young age – it ran in her blood. Her mother was a nurse and her grandmother completed two of three years of nurse training.

But it was only after hearing about the death of her premature, older twin brothers at 26 weeks – one in-utero and the other a few hours after birth – that her specific interest in neonatal nursing grew.

Growing up, Barwick noticed her mother was always sad around early December. Her mother eventually opened up about the loss of her twins in 1968. “I already had an inclination to go nursing and as I got older, mum opened up [about her loss],” Barwick said. “Just talking with her about my brothers and their journey, my inner being felt ‘maybe this is what I’m meant to be doing’.”

Her mother, too, had been a premature baby. But born in the 34-36 week range, she survived – without medical support. “She was brought home in a cot, lined with brown paper and kept by the fire,” Barwick said. “My grandma used to say ‘we’re not sure how your mum’s still here’.”

These days, premature infants can survive as early as around 23 weeks’ gestation, although the shorter the gestation, the more likely a poorer outcome, says Barwick. And survival this early is still relatively new in New Zealand. When it is known a baby will be born early, steroids can be given in utero to aid lung development.

When she started as a neonatal nurse, in 1999, the cut off “age of viability” was around 25 weeks. For anything earlier, intervention would not have been offered.

Today, a mother going into labour at 23 weeks, or parents of an infant born that early, are generally offered a choice on whether they want intervention, with an explanation of possible risks. It is not always an easy choice – risks for the preterm infant include increased vulnerability to infections, lung and respiratory problems including chronic lung disease, intraventrical haemorrhage (bleeding in the brain’s ventricular system) and necrotising enterococcus (perforated intestinal tissue).

Born on the West Coast, Barwick lived in south Otago before moving to Taranaki, aged 10. Her first job was working in a bakery. But when her boss refused to give her an apprenticeship (believing it would be too physically demanding for a female), she took up an earlier offer to take the then-Taranaki Polytechnic’s diploma of nursing. She later completed her bachelor of nursing at Wintec in Hamilton in 2003, then a post-graduate diploma in neonatal nursing at Massey University in 2004.

Barwick’s first nursing job was in aged care, before she moved to Waikato Hospital working with older people’s rehabilitation, then on the renal ward. By 1999, she had finally reached the neonatal ward, her true passion, where she has stayed for 22 years. “I found my place in neonates and it’s something I have enjoyed very much,” Barwick said. “I had a passion for it. I believe in holistic care – you look after the baby and the whānau.”

Waikato has one of the country’s six neonatal intensive care units (NICU), so often deals with the more premature births, generally requiring complex and long-term care. Barwick started out working with the less premature babies (“prems”), born from 32 weeks on. She supported parents with feeding, bathing and medications, if needed, and loved the work. “I had a sense of connection and being a part of their journey.”

After gaining more experience, she went on to work with earlier prems. Barwick is part of the team which goes out and picks up prems and whānau from around the Waikato region – from smaller hospitals, birthing centres or remote areas – by helicopter, airplane or ambulance, depending on the terrain, and brings them to the Waikato NICU.

Neonatal care can be an area of intense emotions, but “we see a lot more joy than sadness”, Barwick says.

She remembers many years ago looking after a premature baby born at 26 weeks. “The eyes had not yet opened. The baby didn’t do so well – their eyes remained closed, so they never saw the world.”

Another time, a family from the United Kingdom lost a premature baby in the Waikato NICU. The family had no relatives in New Zealand, so several NICU nurses attended the infant’s service to show support. “It’s the New Zealand way. If you’ve got no whānau or family, there will always be someone there.”

But on the “joy” side, recently, a pregnant woman in Te Awamutu unexpectedly gave birth at 25 weeks at the local birthing centre after a check-up. Barwick said her team was able to reach, intubate and transfer the baby to NICU where over several weeks he progressed “fairly smoothly”, despite getting no steroids in utero. The baby eventually went home with no need for further medical support.

Families stay longer

With the earlier survival rates, Barwick said, families tend to stay for longer. “You can build up a rapport, as they often stay for weeks, or even months.” One child born very early – at just 23 weeks – stayed for more than six months. The lower survival threshold, though, means more pressure on the units, as the resources have not always grown in proportion. “We won’t turn anyone away. We will find space for them, somewhere,” Barwick says.

Waikato Hospital’s NICU has 41 beds, and 18 nurses per shift – a high ratio for a high-needs area. It runs at 100 per cent occupancy most of the time. When really busy, the unit will liaise with the paediatric ward to accommodate older or more stable babies.

Barwick – who voted to strike this month – said some nurses were getting tired, with the increased occupancy and stretching of resources. “As nurses, we are not getting valued. We should be paid as professionals, for how hard we work, the hours we work.”

Despite the challenges, she loves it. “My ethos is the day that I stop learning is the day I should consider what area I am in – and if I should still be in nursing,” Barwick said. “But it’s been more than 20 years in neonates, and I’m still learning.”

See also Wellington neonatal unit gets big staffing top-up