Table 4.

Talking Points for Neonatal Nurses for Selected Facilitators and Barriers

Category	Goal	Talking Point
Facilitators
Peer Support	Helps the mother realize her experiences of a traumatic birth and her infant in the NICU are shared	Lots of mothers with babies in the NICU find that their own family members try to be supportive but they just don’t understand.
	Helps the mother understand her reactions (e.g., anxiety, not wanting to leave the baby, not finding helpful support from family and friends) are normal	Oftentimes, talking with another parent can be helpful. Have you met any of the other parents? Let me introduce you to Ms. X. Her baby has been through many of the same things as your baby.
Learning from the staff	Reinforces maternal role which increases the mother's sense of accomplishment	Look at how much weight your baby has gained from your breast milk.
	Fosters mother's sense of responsibility for her infant's health	Look how your baby's heart rate stabilizes when you hold her in the position I showed you. She knows your touch and calms right down.
		Your baby tolerates the gavage feedings better when you hold him than he does for any of us. I'm going to watch your "technique" so I can make sure I do it as well.
Barriers
Leaving the baby to go home	Provides the mother with an opening to talk about her reactions to going home and leaving her baby each day.	Most mothers say that the hardest part of the whole NICU experience is leaving the hospital after giving birth and leaving your baby behind. They say it gets harder and harder as they spend more time with their babies and the babies really come to know when they are with their mothers. Lots of time, even close friends and family members do not understand how difficult it is to leave your baby. But, your hormones are "wired" to not want to leave your baby just like any other mother--NICU or not.
Uncertainty	Provides the mother with an opportunity to talk about her reaction to her infant's health and its impact on her life Provides the mother with a safe space to discuss her fears, anxieties	A lot of mothers say that having a baby in the NICU is like being on a roller coaster. There are a lot of different ways that mothers cope with the emotional ups and downs of having a baby in the NICU.
	Helps the mother understand her feelings are normal	Some mothers have difficulty thinking about what it will be like when they take their babies home. Have you thought about what is the first thing you will do when you take your baby home?
Lack of Control	Acknowledges and validates the mother's feelings and helps her understand her experience is normal	Many mothers say it's hard not to be able to take care of their baby all the time and to have to leave him or her with the NICU
	Helps to acknowledge the role of the mother as the primary caregiver while mother and nurse work as partners in the baby's care	It’s a normal feeling for every new mother to have when she leaves her baby in the care of others What makes you feel the most relaxed and comfortable with respect to your baby's care?