You Can’t Prevent Trauma in the NICU—But You Can Change How It’s Experienced

“We are responsible for the conditions we create—though we do not control what another lives.” - Mary Coughlin

There is a phrase I hear often in our field—spoken with sincerity, hope, and a deep desire to do better: “We can prevent trauma in the NICU.”

And I understand the longing beneath it. Because if we could prevent trauma, we could spare babies and families from pain. We could right what feels unbearable. We could make something inherently uncertain feel safe.

But the longer I sit with this idea, the more I find myself asking: What are we really saying when we say we can prevent trauma?

And perhaps more importantly—Who does that belief center?

The Assumption Beneath the Aspiration

To believe we can prevent trauma suggests that trauma is:

• clearly defined

• universally experienced

• and fully within our control

But trauma doesn’t work that way. Trauma is not simply what happens. It is how what happens is experienced, processed, and carried.

It is shaped by:

• the nervous system

• past experiences (long before the NICU)

• meaning-making

• and relationship

Two families can walk through the same clinical course and carry entirely different imprints of that experience. So when we say we can prevent trauma, we risk treating it as a problem to solve rather than an experience to witness.

The Subtle Drift Toward Saviorism

This is where something more subtle and more human emerges. The desire to prevent trauma often begins as care…but it can slowly drift into something else.

A quiet belief that:

• if we do enough

• if we get it right

• if we apply the right model

we can fix what is inherently complex and relational. This is not arrogance. It is not ego in its loudest form. It is what I would call the quiet savior instinct. And here is where the shift happens—almost imperceptibly.

The focus moves:

From: the infant and family navigating their lived experience

To: us—as the ones who prevented harm, who made it better, who got it right

And in that shift, we risk becoming the heroes of the story…instead of honoring the truth that we are not the story.

They are. The infant. The parent. The family.

They are the ones living, enduring, adapting, and making meaning in real time.

Our role is not to step into the center and resolve the experience. Our role is to walk alongside it—to support, to buffer, to witness, to protect what can be protected…without taking authorship of something that does not belong to us. Because the moment care becomes about who we are in the story—the helper, the healer, the one who prevented trauma—we risk losing sight of who the story is actually about.

The Edge of Altruism: When Care Becomes About Us

Joan Halifax speaks about what she calls edge states—those places where our most noble qualities begin to tip into something else.

Where:

• empathy can become overwhelm

• resilience can become rigidity

• and altruism… can become something more complicated

Because altruism has an edge. On one side, there is genuine care:

• the desire to alleviate suffering

• the willingness to show up

• the commitment to serve

But if we are not attentive, that same impulse can slowly pivot from being with others in their experience to needing to feel effective, helpful, or good because of it and this is where the shift can become almost invisible. The care is still there. The intention is still good but something else has entered the space—a subtle internal reward system.

A sense of:

• relief when we’ve “made a difference”

• satisfaction when we’ve “helped enough”

• even a quiet dopamine hit when we feel like the one who made things better

This is human. But in the context of trauma-informed care, it matters. Because when our internal experience begins to orient around:
“Did I fix this?”
“Did I prevent harm?”
“Did I do enough?”

We are no longer fully centered in “What is this person experiencing?”

The Reality of the NICU Experience

The NICU is not a neutral environment. It is a place of:

• urgency

• uncertainty

• separation

• invasive intervention

• and profound emotional intensity

Even in the most compassionate, developmentally supportive units, there are elements that cannot be removed.

A premature birth. A critical diagnosis. The loss of imagined futures.

These are not failures of care. They are realities of the human experience. Which means:

Some degree of overwhelm, stress, and potential trauma is unavoidable. And that truth is not a limitation of our care. It is an invitation to deepen it.

A Trauma-Informed Reframe

What if the goal is not to prevent trauma…but to prevent avoidable harm while supporting the integration of unavoidable stress?

What if our role is not to eliminate the experience…but to shape how it is held? Because we can:

• reduce unnecessary stressors

• protect sleep, development, and relational connection

• include families as essential partners

• create environments of safety and dignity

And perhaps most importantly—we can ensure that no one moves through these experiences alone.

From Control to Relationship

Trauma-informed care is not built on control. It is built on relationship and it asks us to:

• stay present rather than fix

• witness rather than define

• support rather than solve

It invites a different kind of question: Not How do we prevent trauma? But How is this experience being lived, right now, by this infant and this family? And How can I be with them in a way that supports safety, connection, and meaning?

The Role of Humility

There is a humility required in this work. To acknowledge that:

• we cannot control every outcome

• we cannot define another’s experience

• we cannot remove all pain

But we can show up.

With:

• presence

• attunement

• respect

• and care that is deeply human

This is not less powerful than prevention. It is, in many ways, more so.

Closing Reflection

Perhaps the work is not to prevent trauma. Perhaps the work is to ensure that within even the hardest moments:

• there is connection

• there is dignity

• there is meaning

• and there is someone who stays

Because trauma is not only shaped by what happens. It is shaped by whether we were alone in it.

Invitation

As you reflect on your own practice, consider:

• Where might the desire to fix be overshadowing the need to be with?

• When does care begin to orient toward your role in the story rather than theirs?

• What does it mean to offer care that honors the reality of trauma without trying to erase it?

Take care and care well,

Mary