CARE OUTLOUD Podcast
Mary Coughlin: [00:00:00] Welcome, Brit Pados. I am so pumped to have you join us on Care Out Loud podcast. if you wouldn't mind sharing a little bit of how you've evolved to your current role.
Britt Pados: So how did I get to my current role? during my undergraduate program, I got like a little bit of a taste of research and that just kind of was always interesting to me. And I think along the way I've realized I have a little bit of a track record of kind of not following the rules, I went directly from my undergraduate program into the NICU, which was, sort of a no no.
I was supposed to go into, something with adults, exactly. but that just didn't make any sense to me. I knew, from a very early Young age. I just have always been fascinated by babies. And[00:01:00] it did not make any sense to me to go work with adults. I had the opportunity, in my undergraduate program, I did my final clinical rotation in the NICU.
And so they knew me and I was offered a job And I loved it. But, I think having kind of this taste of research and then getting into the NICU, I realized that a lot of what we were doing wasn't based on research, our ability to save these little tiny babies was really very new.
And we just didn't, you know, there wasn't the time yet to have it. Research to support a lot of what we were doing. And there was a lot of things that we were doing that also didn't really make sense to me. And so, I decided to go back and I got my master's and became a neonatal nurse practitioner.
And went into a level [00:02:00] four NICU as a new NNP, which was wild. But I learned so much. I'm so thankful that people gave me those opportunities to do intense things. And in that role, I noticed these babies were surviving being born extremely prematurely or in the NICU I was in, we had, babies who had cardiac surgery.
So they would survive these surgeries that were just incredible. And they would get to the point where they would start eating and that was always kind of this point of excitement because it felt like, especially for the families, it felt like, okay, this baby. has gotten to this really important part of the process and it's the last step before they go home, right?
I would just watch these babies struggle so much with feeding [00:03:00] and it was so heartbreaking for families because it was often the last thing before they got to go home.
Like, you would never, you know, I mean, those are just aren't kind of what's expected of parents to manage, tubes and whatever. But feeding is, and that feels so bad, when that doesn't go well. knowing early on that I wanted to do research, I went to do my PhD program focusing on feeding in babies with medical complexity because we didn't understand why they were struggling so much, and we didn't know how to support them, particularly, babies with cardiac.
Mary Coughlin:
it was such a hit or miss strategy. I think we extrapolated a lot of stuff that we would do with, healthy babies and just figure like, let's try this out and not really appreciating all of the backstory, all of the nuance, all of the I mean, the [00:04:00] experience of the trauma of their medical condition and how it impacted that natural evolution of these skills.
And I don't know if I can say the desires and the relational components of something that is so quintessential about being a baby. that I think we just missed a lot of that. So good golly, what a breath of fresh air and desperately needed science to really uncover that and unbundle that.
So boy, I know a lot of babies that are wicked happy about your trajectory and your experience.
Britt Pados: Thank you. I started thinking about. these feeding challenges from kind of a trauma informed lens. I mean, when you really sit down and think about it, think about all of the things we do to these babies faces and mouths.
Of course, then, when we're like, and here's a bottle or here's a breath, they're like, no, absolutely not. Get that away from me. When I think about it that way, it makes a lot of sense.
Mary Coughlin: Yeah.[00:05:00] But I don't think a lot of folks do think of it that way, you know?
So for you, you observed something, it didn't feel right and it piqued your curiosity to pursue that. And that was well before you you know, went on to become a trauma informed professional, but you felt that something was missing, that there was a gap, is that correct?
Yeah.
Britt Pados: You know, I've always thought about feeding and my research within this lens of stress and trauma. Long before I became a trauma informed professional.
Mary Coughlin: And I think it's fascinating how you've taken this another step further.
you've done the research and you've just made incredibly significant contributions to neonatal nursing to neonatology at large, but you've even now Advanced in your evolution from a professional perspective to now being an entrepreneur and serving and living your philosophy, your your science that you've created in caring for [00:06:00] these babies and families who have survived the NICU, but.
Might be struggling to thrive beyond due to their oral and feeding experiences that they endured in the NICU. Is that
Britt Pados: Yeah, so, I went on for my PhD program and went into the traditional academic role, which was, an incredible opportunity to, get my research off the ground and really had the opportunity to touch the lives of students becoming nurses, When you asked about becoming a trauma informed professional, I read your first book a long time ago, and for many years, I was teaching just one class within the kind of maternal child course. every semester on trauma informed care of the newly.
Mary Coughlin:
really? Oh, that is so wicked cool.
Britt Pados: Yeah, it felt like an opportunity to share my passion with students. one of the [00:07:00] challenges is I wasn't teaching the people who were going to do the things that I was passionate about.
And so, in my evolution kind of came to the realization that I wanted, I wanted to just make a bigger impact than I was able to make in school. So yeah, I took that leap of faith to become an entrepreneur and I started two businesses One focusing on providing clinical care to babies in my community.
I saw, particularly from COVID, a lot of the support systems for new families evaporated. even before that, the amount of support was minimal. I really wanted to get back into Seeing babies and families. so, I have one business where I do my clinical practice and provide education for parents and health care professionals around [00:08:00] feeding.
then I have another business that tests the flow rates of bottle nipples with the goal of providing parents and professionals with the information they need to feed babies
Mary Coughlin: Yeah. I mean, it's just incredible, the work that you've done exposing relevant gaps in how we provide care nurses want to create nurturing experiences, but When you don't have the evidence, you operate on assumptions and your best intentions.
But again, there's no guarantee, that those best intentions are going to play out the way you want to when you have those knowledge gaps. The work you've done with trying to quantify and characterize these different nipples so you can give parents and professionals the information they need to be respectful of the baby's skill set and, and capabilities and, and respond appropriately to those different situations.
And for [00:09:00] parents too, I think, It's not like nurses have this magic about feeding, I mean feeding is a very natural, right, human thing. Definitely, quintessential to being a parent. and so I think that shared passion for wanting to do it right, but not even knowing that, oh, what we're doing isn't right, like, holy moly.
Because I never even thought of that, And then, you come across this, and you're like, how many other things are we are we doing or providing that May not really be the right thing, regardless of our intention.
So I think you really were a pioneer in that work. you focused on the nipple issue But you also saw that it was just one piece of A larger challenge for babies and families that you had the skill set to, support and guide I wonder now, I'm honored that you actually had read the first book And that you were teaching on that, And it also makes me want to [00:10:00] ask the question, so in, in that kind of maybe discovery of that concept and the relevance that it had in the NICU and the journey that you've been on to now becoming, a certified trauma informed professional how has that journey shaped your understanding of the needs of babies families and even clinicians, I'm sure you're you know, you're making, you're, you're doing clinician education around this.
Has that had any influence on that journey and the service that you provide?
Britt Pados: It feels so embedded in everything that I do, it's hard for me to pull out how it has shaped that it is the other part of the journey I didn't mention was my personal experience with the NICU and complicated pregnancy. Learning more about the trauma informed professional program helped me think about my own experience in a trauma [00:11:00] informed way.
You know, I knew it was traumatic. But there's a step beyond acknowledging the trauma to thinking about everything you do within that lens of understanding that trauma and what it means for your life.
Mary Coughlin: I mean, being a mom of a baby who's had that experience?
Britt Pados: we, had a long journey of trying to get pregnant. And then I got pregnant with twins, which was so exciting. And had, you know, a relatively uncomplicated early part of the pregnancy. And then at 23 weeks. Started contracting and you know, at that time, 23 weeks was not considered, able to be saved.
they sent me home and said, see if you can make it another week, we sat at home for a week, trying to make it to that next week. And we did and, but then had [00:12:00] just a really. was in and out of the hospital on bed rest from 23 weeks on and by some miracle, we made it to 34 weeks and delivered, had, the babies were healthy.
I was actually very sick. so we ended up with a C section under general anesthesia. the hospital policy at the time was my husband was not allowed to be in the delivery room because I was under anesthesia, which thinking back feels wrong I was robbed of that experience, but there was no reason why my husband had to be robbed of that experience of the birth of our children.
But that was hospital policy. And so by the time I woke up, the babies were gone. I was so sick that I didn't see them until they were about 16 hours old. my husband was running back and forth between two babies in the NICU and me. And, I, I'm telling him like, go with the babies.
And he's looking at me like, you are not okay. And [00:13:00] you're right. I ended up being okay. And we all ended up okay. if I was the NNP, and I walked into this room, and here's, these babies are okay, and this mom, I would think, okay, this is pretty good.
They're 34 weekers, they don't need any respiratory support. they're okay, but that just, it was like you would miss the whole trauma. Yeah. Right? Yeah.
Mary Coughlin: And
Britt Pados: that's what happens. And I think that experience just totally changed how, I thought about, I mean, we, we meet these families and it's like, we know nothing.
About their story and only in being present with them. Might we develop a relationship where they feel comfortable sharing any of that with us.
Mary Coughlin: So, that's really profound what you just said because you're absolutely right we don't know their story
We need to be present with them. I mean, that's what they're aching for. And yet they don't even realize that's what they're aching for, when you are in a [00:14:00] traumatic situation You're drowning and you can't think of anything else, so has that lived experience and then the work, the passion around the work that you do how do you create that sense of.
of presence, that sense of being seen for these families who have survived that acute slash maybe semi chronic situation, but are maybe now in an outpatient environment They're at least home, which I also, I just realized as I say that, there's some caution around that too, but it doesn't mean that everything is Is right is rain, and I have to come and see you because we still have ongoing challenges that are affecting something that is so quintessential to my child's life, being able to eat and enjoy.
That experience and grow. I mean, obviously an important piece of the eating experience, gaining weight So how do you [00:15:00] approach that level of care with that understanding that you just described?
Britt Pados: You know, I think, the most important thing I do is I make sure I allow enough time this is part of the benefit of owning my own practice people just need to be heard. they want to have somebody ask them how they are doing and ask them about their story. And actually have the time to sit there and listen,
Or equally important to any recommendations I make around feeding, is just in helping them to understand their baby and why their baby is struggling. because you're right, I think there's such a focus in the NICU on getting this baby home that the strategies that are used.
don't really equate to long term success with feeding. And there's kind of this moment once people are home, where they realize that like, okay, our goal now is different.
And so we might need to [00:16:00] change up. what we're doing here. This baby needs to eat like forever. I think allowing people time to understand their own experiences share those experiences and helping them to read their baby.
Mary Coughlin: You know, you bring up different thoughts around this whole experience for the parent, reading some of the literature about parents experience of, you know, transition to home discharge home and the post NICU period, a lot of them feel frightened, overwhelmed, like that safety net is gone now and they're freaking out all understandable, How, in your role seeing this and uncovering these needs these priorities because things have shifted, might feel confusing to a parent who, was on track
Now you're discharged. Now you're on track B. And it's, different language, different expectations, different everything that that disconnect can maybe feel really like [00:17:00] I don't know, disoriented, like, did somebody miss the bus here? Why? Why am I just hearing this? Now? We've been in the hospital for x, you know, kind of a thing.
What kinds of Insights or understandings has the work that you're doing now provided for you that maybe it's important to share back, and as I say this, I realized just because you discovered it and you share it back doesn't mean anything's going to change. But what are the discoveries that you're making that could really maybe help, influence how we're caring for them in that track a.
Yeah, I
Britt Pados: I think it motivates me even more to make change in the NICU. we really need to be from the very beginning thinking about the long term outcomes. I have a paper where I did a meta analysis of the literature on feeding difficulties in children between the ages of one and four who were born preterm and found that [00:18:00] 42 percent of them had Significant feeding difficulties.
That's almost half. And I would say that's probably an underestimate because most of those studies excluded the kids that we know are at highest risk, right? Excluded the children with feeding tubes, which is crazy. so it's probably closer to 50%. So 50 percent of these were babies even born up to 37 weeks.
So even those late, my twin or children That is astounding, we have to do better. one of the things that I've realized, is that I only ever saw babies in the NICU. many of the people who work in the NICU never see them afterward.
they might get the update periodically, or the family might come back and visit. But in those instances, you're only hearing the good things. Only the people who are working in the neonatal [00:19:00] follow up clinics. who do both NICU and neonatal follow up. Or sometimes, there are therapists who see, children in both situations.
But so I would say the vast majority of neonatal nurses never see them after. And so bringing that knowledge of what's happening afterwards back into the NICU and saying this is what's happening. What you do in the NICU really matters. And we need to be thinking about this kind of longer term.
So I would say It has been really important for me to see that and understand that. And then, like you said, bring it back and really motivate change from the very beginning. before we have that first feeding, we have to be thinking about from the moment that baby is born, how are we handling this baby?
How are we touching this [00:20:00] baby? What kind of sensory experiences is this baby having that is going to impact them,
Mary Coughlin: Yeah, not just for feeding but forever. I mean, do you have a sense then like because it does impact absolutely everything
Where do I start? Would you be able to, kind of based on, your experience and your research what are the top, top priorities then? Are there some maybe top two or three priorities that you think are really relevant for clinicians, to kind of get their heads wrapped around so that we can really start improving, the experience of care with a focus on those long term outcomes in the inpatient side.
Britt Pados: Yeah. I would say skin to skin care, we have so much evidence. There is so much research. this skin to skin care is not a nice thing to do. Right? That it was nice for parents. We have so [00:21:00] much research that the, this is a critical component.
To providing excellent neonatal care. it should no longer even be question, it has to be part of our care. And it helps everything, including feeding,
Mary Coughlin: But it's everything for your buck. Exactly. Yeah, I mean,
Britt Pados: And then, prior to feeding, think about every time they touch a baby's face or mouth, how that baby experiences that.
even non nutritive sucking, we have evidence that that's really helpful. We have to think about how we're doing that, that shoving a pacifier in a baby's mouth, sort of propping it up in a way that they have no other option but to keep it in their mouth, that that is not a positive experience, But I think that, when we do start feeding, I would just. love us to [00:22:00] get to a point where we start babies safe. so often, the plan is kind of like, well, let's start them on a standard flow nipple, and then when they fail, we'll go slow flow.
Yeah. Why, we know, which babies are at high risk. let's just start safe. And then, advance them as they grow and develop. So, yeah, that's mine.
Mary Coughlin: I love that you said that. You know, starting them with safety in mind. Because it seems like a no brainer.
We just we don't think very complex. About feeding. I don't think we really appreciate the The intimacy of that experience. I love when you were talking about the, the pacifier thing, you know, and I mean, people, we call it a plug. Right. I mean, we, we plug them up.
And then we're trying to figure out ways of everything but duct taping it across their [00:23:00] face to keep it in. And again, I think we're well intentioned, but incredibly misguided and misinformed about what that experiences is. And this one word just kept jumping up. So I have to, you know, it's really about that idea of human dignity.
You know that we don't treat these little people with the dignity and respect of another fellow human being. Although I think we're really short on that dignity and respect with fellow human beings in general, It's disheartening. And particularly when we're having these encounters with people that are figuring out.
what it is to be human on our watch. So these experiences that they're having that are frightening, that are aggressive, that are overwhelming, are wiring their brains for how they need to be to navigate [00:24:00] their life.
Britt Pados: You know, this is something you talk about all the time and I talked about it in the context of feeding to learn something new, we have to feel safe and actually be safe.
Yes. And that's true with feeding right babies have to. Be, actually be safe, because it is very possible that the way we're feeding them is not safe for them. And they also have to feel safe in order to learn this new skill of eating, which they haven't been asked to do before. even with healthy full term babies, whenever I'm teaching parents about feeding, I always talk about it as your offering.
The feeding. Exactly. And then they have to give you permission. Yes. Right? we're never putting a bottle nipple in a baby's mouth without them kind of realizing what's happening and opening their mouth and accepting it,
We know this baby needs to eat if they don't [00:25:00] want to eat. That's really scary. But they have to give us permission or they get to a point where they completely refuse. And then we're in a much bigger place.
Mary Coughlin: I mean, and we have strategies that we can employ when they don't give us permission.
I mean, we may not want to use the feeding tube or some other device but for safety sake, we have to do that. just like that example you gave about, the fast flow. And if he chokes, well, then we'll try something different. Really? Is that you're really going to go with that as your best option coming out of the gate?
Yeah, it just, it doesn't feel like you're caring about this situation. You're just kind of checking off a box,
Britt Pados: And I mean, tube feedings. the way we talk about tube feedings with parents.
Mary Coughlin: Yeah.
Britt Pados: Oh, it can either feel like a failure.
Or it can feel like an opportunity. and I think our words, especially as nurses, when we're talking about tubes, helping the family to understand that this is a way [00:26:00] that we can make sure they're getting the calories that they need for their brain to grow and develop and their bodies to grow, which is what we need, while also keeping this feeding experience really positive.
So that they want to do it, but I think that our words really matter. And can make such a huge difference for how families feel about the situation.
Mary Coughlin:
Oh my gosh. I mean, we could talk forever about that particular subject because it is, it's just so critical. But I appreciate, how you've positioned it because there are so many gaps so many opportunities for education, for ongoing learning across all the disciplines.
But I do emphasize nursing, a lot because we're there, the majority of the time it, everything's happening on our watch. And so we really need to be dialed into the experiences that we're creating. With the idea of preserving not just, the short term objectives, but the [00:27:00] integrity of this individual over their lifespan, the work that you're doing in my estimation just really exemplifies what it means to care out loud.
I mean, you just care out loud in such a big, meaningful. intellectual and compassionate way. I do want to get a sense from you too. Like, you know, when you saw that, you know, she, oh, she doing a care out loud podcast, what the heck is that all about?
What did, what did you think about carrying out loud and how did it hit you? Well,
Britt Pados: I love the name because a lot of the people who listen to this podcast are in what you would call caring professions, right? We do what we do because we care. We just kind of get desensitized to what we're doing.
And I think it takes that step of actually saying it out loud [00:28:00] to remind ourselves and everyone around us of how important the things that we do are. I think one of the really wonderful things about the Trauma Informed Professional Program is giving people the words. To communicate that to the rest of the world, And then, using those words, so that other people start to build, this framework.
And it's not just in neonatal care. It is in all healthcare. I've heard other people talk about their trauma-informed professional program saying how it made them a better human.
I probably wrote something like that in my reflections on the program. we just need more people talking about it.
Yeah, you know, trauma informed care it's a term now that is all are saying, and I think Really starting to use those words out loud and putting what we're [00:29:00] doing into that context and sharing it with other people, whether it's our individual interactions or on a, broader scale of teaching and publishing
Mary Coughlin: like that.
I love that you said that. That last bit about in whatever way is, is your way, because that's the other piece of this is, this is not a cookie cutter approach to care out loud is just really an invitation, bring your best self, bring your passionate self
To, you know, your story when we kicked off the podcast and you kind of laying out, your roadmap that brought you to this place now where it seems is giving you great joy sense of fulfillment I'm doing this work and we're all invited to step out of line and care out loud through our own calling whatever it is that lights us up and brings us joy.
Britt Pados: and really, I think it's a process of learning how to do all of those things while also caring for ourselves.
Mary Coughlin: Yeah, well said. Oh [00:30:00] my gosh, thank you so very much for all of this. I do have one final, well actually I have two final questions, right? Just one nugget of insider wisdom that you'd like to share with folks that are listening that that you've gained over, over your career that you'd like to just kind of impact.
Hmm,
Britt Pados: A very simple one would be the labels on bottle nipples do not mean anything. There is no standardization or regulation of what those things say, so even if something says slow flow, it just doesn't mean anything Maybe join the effort to make a change there.
Mary Coughlin: join your network, and I'll put all of this information down below in the show notes. there is evidence that Brit has curated all of this information that can help you make choices with knowledge to best serve your patients. that's what it's all about safety.
Now the fun question. Okay. So this is what I'm calling a [00:31:00] few of my favorite things. Part of the of the podcast. So I'm going to rapid fire you. Whatever pops into your head. Don't overthink it. Ready? Favorite book. Quiet. Oh, excellent. Favorite movie.
Britt Pados: The proposal.
Mary Coughlin: Favorite song.
Pass. Favorite activity.
Britt Pados: Watching my kids play soccer. Perfect.
Mary Coughlin: And your favorite color. Now we've gotten a little bit behind the curtain in understanding Brit Pados a little bit deeper, not just her big brain and big hat, but her big fun too. And I want to thank you so very much. You're just so gracious to share all of this information.
Thank you so much for having me.
