Timothy made a sudden and early entry into the world which required him to experience the first ten days of his life in a Neonatal Intensive Care Unit (NICU). In addition to taking photographs for family and friends to see Timothy – in many NICU’s only parents and grandparents are only allowed to visit – we wanted to record his time in the unit and his road to recovery. By taking photographs we were able to record the milestones as he improved over the 10 days he spent in the unit, including graduating from a breathing tube to CPAP prongs to breathing without assistance and then to only having basic monitoring equipment which allowed him to receive his first breastfeed.
NICU, to the uninitiated, is a strange, stressful and emotional environment. While some of our time was spent simply staring at Timothy, photographing him gave us something else to focus on, especially as the photographs would also give Timothy’s siblings their first views of their brother (children – being the germ-ridden monsters they are – were not allowed inside the NICU). While we were able to draw on my photographic experiences to ensure my images were well exposed photographs, the unfamiliar challenging environment can create photographs which may seem disappointing. This is the reason we chose to write this, in hope that others on the NICU journey will be able to use the information to help record quality images of their babies.
Depending on the individual NICUs’ policies, mobile phones and iPads will often have to be switched off, meaning that their cameras cannot be used. This means a digital or film camera will need to be used, but even disposable cameras can provide memories of the time in NICU. NICU staff can not only advise on the hospital’s policy but, depending on their busy work schedules, can take photographs of you and your baby, some NICU’s even have their own camera and photo printer for taking photographs of your baby.
While camera flashes are associated with indoor use, NICUs are brightly lit environments and will usually have sufficient light for photographs to be taken without flash. Unstable premature babies are sensitive to light and noise and while to adults these simple stressors have little effect, to a premmie they can cause sudden variations in heart rate, respiration and oxygen saturations – available light is what should be used to photograph your baby. Some NICUs do not allow flash photography.
While tripods will allow longer exposures and greater depth of fields, they can take up a lot of space and become an obstruction to hospital staff so are also not recommended – a monopod, if used carefully, might be useful in low light areas. In addition, if the baby is in an incubator or Perspex crib, often to maintain the baby’s temperature, then flash reflecting off the plastic obscures the view of the baby so better results are obtained by switching off the flash. For babies in an incubator reduce the effect of glare on the plastic by opening the incubator window and shooting through the opening.
There are various levels of NICU, from full intensive care to high dependency units and nurseries depending on the levels of care the baby needs. The level of support required will vary the level of interaction you can obtain with your baby. If the infant is intubated (breathing tube inserted) or on CPAP (positive pressure breathing support via nasal prongs or a small mask) the baby can only be moved for nursing care – at all times the care of the baby comes first and definitely over any photographs. Parents can, and are often encouraged to, assist the nursing staff when providing care (including feeding, cleaning, nappy changing and recording temperature) and this allows photographs showing family interaction to be taken.
With modern compact digital cameras simply setting automatic, indoor or low light settings (depending on the individual model) will produce good results, but an SLR camera will produce excellent photographs. For the photographs of Timothy, the camera was set at ISO 1600 and shutter speed of 1/125th of a second (any slower may result in camera shake unless your camera has image stabilisation) resulting in a f-stop of around 2.8 – which gave a nice short depth of field to keep the background out of focus. If zoom lenses do not allow such a wide f-stop, changing to prime lenses, such as a 50mm or 90mm f1.8 lens or similar.
When photographing the baby, unless you are taking pictures of hands or feet, always try to focus on the eyes. When looking at photographs you are always drawn towards the eyes so having the eyes in focus will mean the photographs don’t look funny or blurred. Obviously if the baby is jaundiced (high bilirubin levels) they may be under strong phototherapy lights and wearing an eye mask to protect their eyes, so another focus point will be required.
Each baby will have a schedule of care, including times for staff to record the babies medical status, feeding and cleaning. Depending on the baby’s condition, parents can assist with these and offer opportunities to get images. Even if the baby cannot be held, it may be possible for photographs to be taken with parent’s simply touching their baby, for example holding hands or stroking their head.
For premature babies it is often difficult to describe how small they actually are, remembering to take a photograph with, for example a parent’s wedding ring, gives a size comparison. Once you have your photographs don’t be surprised if they have colour casts. NICUs often have mixed light sources, such as daylight from any windows and fluorescent lights (which produces green skin hues). If these cannot be corrected using computer programs such as Photoshop or Elements, then simply turning the photograph black and white can create timeless and dramatic images.
Newborn babies often have extremely red skin and may also be jaundiced. While recording the actual skin colour can be considered as part of the journey through NICU, it can be nice to show friends and family images of the baby where the colour is more natural. Using Photoshop to reduce the saturation for red and yellow will result in skin tones that are more pink.
When documenting the story of the time spent in NICU, remember to ensure you photograph the milestones and bonding moments, such as the first hold, first non-syringe feed and first bath, not to mention the discharge journey. If I could recommend one thing, it is take lots and lots of photographs, sure some may not turn out, but there will be others which will create an emotional memory of their journey. Even in the NICU babies grow quickly and it’s easy to forget how small they were… and don’t stop taking photographs once they are at home!
This article was first published in March 2014 on the Gary Wilson Photography blog – due to the importance of capturing this part of a newborn’s life, we have chosen to re-publish it to help parents photograph their NICU babies.
We would like to dedicate this post to the staff of King Edward Memorial Hospital (KEMH) who took such good care of Timothy (and his parents!) in 2014 and then Theodore in 2015.