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.


  • Darlene Hall

    You have described NICU in its entirety so well. I have had a NICU journey with my ex33 weeker.
    My hat honey comes off to you and your fellow nurses/drs/ social workers who guide & support us new parents and teach us to care for such tiny humans. Xoxo you guys deserve so much more

  • barbara baker

    my grandson was born very premature i never knew this world existed i never expected to see a baby from head to bum about 6 inchs long with bright red see through skin u could see his internal organs through his skin little legs and arms like twigs even the smallest nappy reached up to under his arms i must be honest i didnt think he would make it we started counting hours then days and so on we nearly lost him so many times but he fought and he is here with his family who we can never thank the teams enough for saving him and our daughter the hugest thank u possible

  • Vicki Berry

    30 years ago, our son spent almost 2 weeks in the NICU, having been born at 33 weeks. He was amazingly big at 4 pounds 14.5 ounces and 18.75 inches. He had breathing issues and jaundice, and other things going on, and it was terrifying the first time I got to see him after his birth. They brought me to the unit in a wheelchair, and I scrubbed for 5 minutes and gone up, and then went and stood by his side, overwhelmed by all the tunes and wires and monitors that were attached. But the nurses were SO amazing and wonderful and helped me overcome my fears and encouraged me to touch him and talk to him, even when I couldn’t hold him yet. We were told to expect him to be there until around his original due date, but he amazed us all by going home after just 2 weeks. He only weighed 4 pounds and 10 ounces when we took him home, but he was eating well and thriving! By 6 weeks he was already up to 6 pounds! The nurses and doctors were absolutely amazing and I am still so very thankful for them 30 years later as I see my adult son with his own children, and I know it is possible because of the care he received in that NICU, at Baptist Hospital in Montgomery, Alabama in 1984!!

  • Rhonda

    My son was born at 25 weeks and weighed 1lb 7 oz. We went through many trying times, however he is now 27 yrs old and has been such a joy in my life. He was the smallest baby our NICU in my hometown had ever had and they told us his chance of survival was 10% right before he was born by emergency c-section, and then right after, they said his chances were 25%, so he has beat all the odds. He was so very tiny, and yet such a fighter. I spent every waking moment at the NICU and the nurses were so very friendly and would answer phone calls in the middle of the night if I just woke up and needed to hear he was ok. He has had several eye surgeries, and hernia surgery, and has now been diagnosed with glaucoma and had to have a surgery on his right eye and 2 laser surgeries on his left, but now has that under control. I am so thankful for all the great care we received at our local hospital. He is very healthy other than the glaucoma, and has a full time job that he loves. The doctors had told me that I might just want to terminate my pregnancy and try again, because there was a great chance of so many things going wrong, but I am so glad I didn’t do that. My son is my whole world. I have seen the heartache as well with other babies that were in NICU at the same time my son was, and friends who have had preemie babies, so I know how hard it is for the parents that don’t have as positive an experience as I had, but I assure you that no one works harder for your child than the nurses that are in NICU 24hrs a day. Of course the doctors play the lead role in their survival, but the nurses are there with them all the time and I consider their role just as important if not more so. Thank you so much to all the nurses and doctors who have the knowledge and patience to deal with these tiny individuals on a daily basis.

  • Autumn's Momma

    There are no words to truly describe the NICU experience. Everyone has a different experience. There are no words to truly describe the emotional trauma one goes through along with truly feeling blessed at the same time. Sometimes the experience starts before the NICU, or at least in my case it did. This experience has changed my heart in many ways. I’m sitting here reading this article, while watching twins being admitted into the room next to my daughters, and all the emotions and memories from 4months ago and being pregnant are flooding my thoughts, and all I can do is sit here and pray for the family being introduced this world and pray that their experience be a happier one than mine.

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