Role of Neonatal Care Planning Before Delivery

Neonatal care planning is the process of preparing for the health and medical needs of the newborn before delivery. While many babies are born healthy and require only routine care, some may need specialised attention due to prematurity, growth issues, maternal health conditions, or anomalies detected during pregnancy. Planning ahead ensures that the right resources are available at the time of birth.

The transition from prenatal to neonatal care is a critical period that benefits from coordination between the obstetric and paediatric teams. When potential issues are identified during pregnancy, the neonatal team can be briefed in advance, equipment can be prepared, and the delivery can be planned at a facility with appropriate neonatal care capabilities.

In Visakhapatnam, hospitals with neonatal intensive care units (NICUs) serve as referral centres for high-risk deliveries. Prenatal identification of babies who may need NICU care allows for planned delivery at these centres, avoiding the risks associated with emergency transfers after birth.

Several maternal and fetal conditions identified during pregnancy influence the level of neonatal care required. Preterm labour, which results in delivery before 37 weeks, is one of the most common reasons for neonatal intensive care. Premature babies may need respiratory support, temperature management, and specialised feeding until they mature enough to function independently.

Fetal conditions detected on ultrasound, such as congenital heart defects, diaphragmatic hernia, or gastrointestinal abnormalities, require surgical or medical intervention shortly after birth. Knowing about these conditions in advance allows the neonatal surgical team to be prepared and the parents to be counselled about what to expect.

Maternal conditions such as gestational diabetes, preeclampsia, and Rh incompatibility also affect the newborn. Babies born to mothers with gestational diabetes may experience low blood sugar and require monitoring. Rh-negative mothers carrying Rh-positive babies may need anti-D immunoglobulin during pregnancy, and the baby may need evaluation for jaundice after birth.

The choice of delivery facility is a key component of neonatal care planning. For uncomplicated pregnancies, delivery at any well-equipped maternity centre is appropriate. However, when prenatal assessments indicate potential neonatal complications, delivery at a hospital with a level II or III NICU is recommended.

Level III NICUs in Visakhapatnam offer advanced care including mechanical ventilation, surfactant therapy, phototherapy, intravenous nutrition, and surgical capabilities for neonatal conditions. Delivering at such a facility eliminates the need for postnatal transfer, which can be stressful for the family and carries risks for the baby.

The obstetrician and paediatrician can work together to recommend the most appropriate delivery location based on the individual risk profile. Parents should discuss their options during the third trimester and make arrangements in advance, including registration at the chosen hospital and transport planning.

Effective neonatal care planning requires seamless communication between the obstetric team managing the mother and the neonatal team that will care for the baby. Prenatal consultations with the neonatologist allow parents to understand what care their baby may need, ask questions, and mentally prepare for the postnatal period.

During these consultations, the neonatologist reviews the prenatal records, discusses the expected neonatal course, and explains the facilities and equipment that will be available. This transparency builds trust and reduces anxiety. Parents who have met the neonatal team before delivery often feel more confident and involved in their baby's care.

Even for healthy full-term babies, basic neonatal care preparation is important. Parents should arrange essential items such as appropriate clothing, a safe sleeping space, and supplies for feeding. Understanding the importance of immediate skin-to-skin contact, early initiation of breastfeeding, and the vaccination schedule helps parents support their baby's health from the first moments of life.

For babies expected to need NICU care, parents should prepare for the possibility of separation, longer hospital stays, and a gradual transition to home. Learning about NICU routines, kangaroo mother care, expressed breast milk feeding, and the milestones the baby needs to achieve before discharge helps parents participate actively in their baby's care journey.

Neonatal care planning is not only a medical exercise but also an emotional one. Learning that a baby may need intensive care after birth can be distressing for parents. Prenatal counselling by the obstetric and neonatal teams provides an opportunity to address fears, set realistic expectations, and offer reassurance about the quality of care that will be provided.

Family support is crucial during this period. Informing close family members about the care plan, expected hospital stay, and how they can help after the baby comes home creates a support network that benefits both the parents and the baby. In Visakhapatnam and across India, the extended family often plays a central role in newborn care, and involving them in the planning process strengthens this support system.