Democracy in the NICU — Care, Consent, and Control

"Every time we honor consent, we practice democracy. Every time we restore voice, we reclaim our shared humanity." — Mary Coughlin

We often think of democracy as something that happens in the voting booth or on Capitol Hill.
But democracy lives—or dies—in the everyday.
In the classroom. In the courtroom. In the clinic.
And yes, in the NICU.

Because when we strip it down to its roots, democracy is about voice, agency, and relationship—the very things that trauma steals, and healing restores.

The NICU as Microcosm

Nowhere is the tension between care and control more visceral than in the Neonatal Intensive Care Unit.

Parents are told to trust the experts.
Clinicians are trained to follow protocols.
Decisions are made at lightning speed, often with lifesaving stakes.
But in the rush to preserve life, we sometimes forget to preserve humanity.

Who gets to make the decision?
Who holds the knowledge?
Who holds the power?

These questions don’t just shape medical outcomes—they shape how families remember, relate, and recover. They shape how nurses stay connected—or shut down. They shape how babies feel in their bodies.

And they echo the very questions at the heart of a democratic society.

The Trauma of Disempowerment

In trauma-informed care, we recognize that trauma isn’t just about what happened—it’s about what was taken away:
Voice.
Choice.
Safety.
Connection.
Dignity.

When a parent is spoken over instead of spoken with…
When a nurse is silenced for questioning the plan…
When a baby’s distress is minimized because “they won’t remember”…
We’re not just violating principles of best practice.
We’re violating the spirit of democracy.

Trauma-Informed Consent Is Democratic Practice

Consent is not a checkbox.
It’s a relationship.
It’s a conversation rooted in respect, transparency, and shared power.

This is what a trauma-informed democracy looks like in the NICU:

• Asking with instead of telling to

• Making space for uncertainty, emotion, and embodied wisdom

• Trusting that families—and frontline clinicians—hold vital knowledge

• Seeing the baby not as an object of care, but as a person with rights and needs

This is the kind of democracy that heals.
The kind that starts from the inside out.
The kind that says: “You matter. Your presence matters. And we are in this together.”

Reflection Prompt

Where in your practice or life do you experience tensions between care and control?
What would shift if consent became a conversation instead of a transaction?

We don’t need to wait for a better system to be handed to us.
We are already the weavers.
Every conversation, every collaborative decision, every act of presence is a thread.

And the NICU?
It’s not just a place of clinical care.
It’s a place of relational courage, where democracy can begin again.

Next up in the series:
Post 5: The Great Awakening — Reclaiming the Soul of a Nation

With care, courage, and an unwavering belief in our capacity to heal,
Weave on, my friend.
—Mary

P.S. If this reflection stirred something in you—if you’re longing for a way to live and lead from these values—you might be ready to become a Trauma-Informed Professional.
Learn more about TIP 2.0 and how it’s transforming care, connection, and leadership.
Explore TIP ➝https://www.caringessentials.net/tip-certificate-program