Recognizing Our Smallest and most vulnerable patients

By Marie Stinebuck, MBA, MSN, ACM

September was NICU Awareness Month, giving us time to recognize our smallest and most vulnerable patients, the professionals who care for them, and the families whose lives can change in an instant. This is also a topic I personally feel close to as the first 10 years of my nursing career were spent working in L&D and the neonatal ICU. My second child was also a NICU baby for the first month of his life.

Across the country, some communities have limited or no access to obstetric services and as the healthcare landscape continues to change and reimbursement decreases, the challenges for rural hospitals to provide maternal services becomes more challenging. When services are no longer offered in a rural community, a pregnant patient may need to travel a significant distance for routine prenatal visits, testing, maternal-fetal medicine appointments, or delivery. For someone with a high-risk pregnancy, that travel may be required more frequently.

Distance is more than an inconvenience. Each appointment may require reliable transportation, money for gas, time away from work, and childcare for other children. Weather, road conditions, or the inability to take unpaid time off may also affect whether a patient can keep an appointment.

When these barriers cause delayed or missed prenatal care, the healthcare team may have fewer opportunities to identify and manage complications early. Conditions such as high blood pressure, diabetes, abnormal fetal growth, or signs of preterm labor may become more difficult to monitor.

If the baby requires specialized neonatal care, the family’s challenges may increase significantly. The mother may deliver far from home, or the newborn may need to be transferred to another hospital with a higher level of NICU care. In some cases, the mother and infant become patients at different facilities while the mother continues to receive postpartum treatment.

Once the mother is discharged, the family must determine how to remain involved in the baby’s care. A NICU stay may last days, weeks, or even months. During that time, parents may be balancing transportation and hotel expenses, meals, employment responsibilities, childcare for siblings, and the ongoing cost of maintaining their household.

Recent federal healthcare decisions may place additional pressure on rural community hospitals already struggling to maintain maternity services. The 2025 federal budget reconciliation law reduces Medicaid funding over time through changes in enrollment and hospital payments. These changes could worsen access to rural maternity care by increasing financial pressure on hospitals, potentially contributing to additional service reductions or closures. For women and families, losing local maternity services can mean longer travel for delivery, greater transportation and childcare costs, and difficulty reaching care when complications arise. These challenges existed before the recent law; the concern is that funding reductions could deepen existing gaps in maternal care.

Distance can also affect the family’s preparation for discharge. Parents who cannot be at the bedside consistently may miss care conferences, feeding education, hands-on practice, or training related to medications and medical equipment. They may have fewer opportunities to build confidence in caring for a medically complex infant.

Case Management and Social Work should become involved as soon as a transfer or prolonged NICU stay appears likely. Families may need home-health services, medical equipment, medications, early-intervention services, and frequent specialty appointments. The plan should consider not only what the infant needs, but whether those services are available and accessible where the family lives.

NICU Awareness Month reminds us that caring for a newborn means caring for the entire family. When we identify barriers early, avoid judgment, and connect families with meaningful support, we help parents remain involved in their baby’s care and better prepared for the day they can finally go home together.