Fee FiCare Fo Fum: Writing new family stories in neonatal care.

Congratulations, you have been selected to play the part of Jack in our new production of Jack and the Beanstalk!

We have a slight problem, though: there is no script. You'll have to just make it up as we go along. But that's ok, you know the story, right? You can work out what to say and do. You know to take the cow to town, to swap it for the magic beans, to hand them over to your mother, to climb the beanstalk that grows in their place next morning, and to... wait!

We can imagine your surprise to find that there's nothing waiting at the top of the beanstalk. No castle, no giant, no golden eggs.

How will you respond now that the carpet has been pulled from under your feet? Do you climb down? Who will be waiting at the bottom? What will you say next? The pressure is on - you have the starring role and people are looking to you to know what to do. How does it feel?

This, in essence, is the experience of a parent in neonatal care. 

The stories we encounter through life provide us with a set of expectations about how the world works. They provide a model of how to act. This is nowhere truer than of how we learn to become a parent. From an early age we unconsciously learn how to occupy the parenting role through stories we hear: accounts of our own upbringing, games of “Families” on the playground, and the TV shows we watch.

When a story starts to unfold with an unexpected plot, unfamiliar characters, or chapters that feel uncertain, it’s no wonder that we feel in a limbo: we don’t know how to proceed. For parents whose baby is born early or needing hospital treatment, the experience doesn’t compute: there is no script for this, no story that sits behind it all guiding what might happen next. It’s like they have reached the top of the beanstalk to find there is no castle.

"There is no script for this, no story that sits behind it all guiding what might happen next"

Families in neonatal care often describe this limbo. Their expectations of ‘how to be a parent’ are thwarted. Purpose, hope and identity all become fragile, especially sensitive to the words and actions of others: friends, family, neonatal staff. This is one of the factors that lead parents of babies in hospital to experience anxiety, low mood and shame. It can undermine confidence and impact in the short and long term on parents’ ability to heal from neonatal trauma.

Family integrated care aims to scaffold purpose and confidence for parents by increasing collaborative partnership between families and teams. This is more than just a series of tasks to achieve together, however. Families also need our help to re-author their stories of parenting: What do they care about? How will they communicate together about important decisions? Who is the baby they are meeting, and how does this compare to who they expected? How much will they become a clinical expert, and how will they ask for help? These stories will shape their lives from hospital discharge and for many years hence.

On this new, unfamiliar stage, families are improvising and we are their supporting cast. This is not a quick process and needs relationally focused care: trust, connection and compassion allowing tentative new stories to be written.

But caution is advised. It is easy for those of us who work in this setting, who have seen this show many times before, to make assumptions about the kind of re-writing that needs to happen. Consider this:

It is possible that, reading this post, you didn’t know the story of Jack and the Beanstalk. The roles, the plot, the whole meaning might not have felt familiar. If you didn’t grow up in a culture of Indo-European storytelling, your upbringing might have been shaped by different stories. Similarly, different local and global cultures tell different stories about what it means to be a parent or in a family. If we assume a shared story about ‘Family’ in Family Integrated Care, we risk creating further distance and disconnection for families who are different to us.

Different local and global cultures tell different stories about what it means to be a parent or in a family

Showing genuine curiosity for a family’s storytelling offers a means of connection, trust and dialogue across difference.

The following questions might help you hold onto this curiosity:

• What parts of this family’s story have been thwarted by a neonatal stay?

• What parts of their story really matter most to them?

• How will this neonatal chapter fit into their wider family story?

• How do they tell this story?

• How can I help them write the next chapter in a way that fits for them?

If you are interested to think more about this topic, and other aspects of relational practice in perinatal or paediatric care, you might be interested in our upcoming webinar series.

If you think your team could benefit from some focused support from us, check out what we can do to be helpful, and what others have said about our work.

Thanks for reading!