2025 • Developmental Observer • 17 Introduction From the earliest days of my pregnancy, I felt an unshakable, embodied certainty that my child would be born prematurely. This intuition defied biomedical categorization: I was 31 years, healthy, with no underlying conditions or risk markers. Yet my visceral sense of vulnerability guided every decision I made. This paper examines how such embodied knowing—often dismissed as anecdotal—can play a critical, clinically relevant role in neonatal care. Parental Intuition as Multidimensional Knowing Parental intuition often presents as pre-reflective and bodily, a “gut knowing” that emerges before conscious articulation.1 Far from mystical, this form of knowledge synthesizes subtle cues and lived relational context, allowing parents to detect changes in their child’s condition that may precede clinical markers.2,3 This intuitive knowing is also deeply relational, shaped by close observation and attunement to a specific child’s patterns of behavior, breathing, or demeanor. Parents develop what is often described as tacit knowledge—an embodied, con- text-sensitive awareness that can alert them to signs of distress invisible to others. Research confirms that parents sometimes detect early signs of deterioration before clinical metrics register concern.1 In this way, parental intuition acts as both a psychosocial and clinical resource. It enhances caregiving efficacy, informs communication with providers, and serves as a protective factor in moments of ambiguity or risk. Clinical Intuition and the NIDCAP Model Clinicians, too, rely on intuition—especially in high-stakes, data-sparse environments like the NICU. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP) offers a structured framework for training providers to interpret behavioral cues—such as posture, facial expression, to self-regulation—as indicators of an infant’s internal state.4 In the NIDCAP model, intuition is neither incidental nor unscientific. Instead, it is treated as a skill that can be culti- vated through observation, reflection, and embodied clinical learning.2 Clinicians are taught to recognize subtle, non-verbal signs of stress or stability in the infant, reinforcing that clinical excellence is as much about sensory acuity and presence as it is about technical skill. This alignment of intuition with structured clinical train- ing helps bridge the epistemological gap between empirical and experiential ways of knowing, allowing for a more holistic model of newborn care. Case Context: Stress, Vulnerability, and Embodied Knowing My own pregnancy unfolded within a convergence of desta- bilizing stressors—what some might call a “life quake.” After disclosing my pregnancy, I was terminated from employment, severing financial security and professional identity at a critical time. Our home sustained significant environmental damage from flooding, necessitating partial displacement. A fracture caused by an undiagnosed bone cyst introduced prolonged physical pain. I also experienced Vanishing Twin Syndrome, mourning the intrauterine loss of one twin while continuing to carry the surviving fetus. These events were compounded by a severe case of H1N1 influenza contracted during the height of the H1N1 pandemic. Living in a rural, resource-constrained community further magnified risk, as access to emergency care was limited. The stress continued with an unexpected jury summons during my recovery, adding legal obligation and physical exhaustion to an already strained system. These intersecting domains—medical, economic, legal, and environmental—collectively shaped my physiological development. Chronic maternal stress, as articulated by Cous- sons-Read,5 alters immune and endocrine function, thereby contributing to adverse birth outcomes. McEwen6 conceptual- izes this phenomenon as allostatic load: the cumulative “wear and tear” on the body resulting from prolonged stress activa- tion, which disrupts neuroendocrine, immune, and cardiovas- cular systems. These embodied disruptions heightened my reliance on intuition as a navigational tool. Consistent with Shaw et al.,1 this intuition may be best understood not as abstract instinct but as a form of practical, embodied knowledge—developed through constant relational attunement to fetal cues, emotional Parental Intuition and Discerning Cues Katie Reginato Cascamo, MA DOI: 10.14434/DO.V18I2.41643Courageous Steps, Gonzaga University USA Illu st ra tio n: V ec to rS to ck , c or et x_ pr o 18 • 2025 • Developmental Observer states, and subtle physiological changes. In contexts where clinical metrics were delayed, ambiguous, or insufficient, intuition emerged as both a psychological and physiological anchor. At seven weeks gestation, my spouse and I debated whether to seek care from a trusted obstetrician located 100 miles from our rural home or to remain within the local rural healthcare system. In deference to my husband, I opted for the local provider—an experienced clinician operating within a system that, at the time, was ill-equipped to fully support his clinical judgment. Throughout the pregnancy, I frequently expressed intuitive insights, which were often met with responsiveness, even when they diverged from conventional timelines. At twenty-one weeks, when my son’s future godmother offered to host a baby shower, I instinctively replied, “at twenty-three weeks.” At twenty-four weeks, I purchased Emergency Airlift Insurance, compelled by a strong premonition of imminent complica- tions. A second baby shower was held at twenty-six weeks. Upon returning home, my parents and husband assisted in completing our son’s nursery by twenty-eight weeks. By twen- ty-nine weeks, I had the birthing bag packed and positioned by the door. The Night of the Airlift: A Clinical and Existential Turning Point The night I was airlifted—amidst a blizzard and subzero tem- peratures—marked a defining moment in my life. The fixed wing plane was not merely transport but a threshold. Upon arrival, a coordinated team of clinicians moved in attuned silence. Their actions, while technical, carried an unmistakable presence—a relational synchrony that communicated urgency, respect, and care without words. This moment of embodied coordination echoed what Jaworski7 calls the “Source”—a generative field of collective awareness that lies beneath cognition. It was a moment in which my intuition, the clinicians’ responsiveness, and the high-stakes context converged into a lived experience of care that was at once clinical, emotional, and existential. This experience did not just change my trajectory—it be- came the foundation of my future scholar-practitioner inquiry. Intuition as a Source of Clinical and Systemic Learning Intuition, as Jaworski7 notes, is not merely a private insight but can operate at a collective level—informing leadership, systems thinking, and organizational learning. In NICU and maternal care settings, decisions often must be made rapidly, under con- ditions of incomplete data. In these contexts, intuitive discern- ment complements empirical reasoning. Moreover, integrating intuitive knowledge into clinical systems enhances not only decision-making but also trust and relational safety between families and providers. Validating parental intuition can foster stronger partnerships and reduce missed warning signs, especially for infants who present atypi- cally or whose conditions escalate suddenly. Extending Intuitive Listening Across the Continuum of Care To maximize the potential of intuitive practices, we must ex- tend them across the perinatal continuum: 1. Prenatal Care: Collaborations with obstetricians, midwives, doulas, and community health workers can integrate intu- itive listening into prenatal visits, especially when patients report embodied concerns that defy clinical prediction. 2. NICU Practice: Embedding trust-building conversations that validate parental intuition as credible can improve responsiveness and foster a more inclusive clinical culture. 3. Post-Discharge Support: Supporting parents to continue trusting their embodied insights equips them to navigate caregiving responsibilities for medically fragile children over time. These extensions position intuitive listening not as a soft skill but as a sustained, relational practice that supports resil- ience, improves safety, and enhances outcomes.1,2,3 Developing Intuitive Listening Skills Mothers can develop intuitive listening with their infants through practices that blend embodied awareness, reflective attention, and responsive caregiving. During pregnancy, tuning into physical and emotional changes helps mothers recog- nize embodied signals that often precede clinical evidence, particularly in the context of prenatal stress and its effects on development.5,6 Intuition should be acknowledged as a form of tacit knowledge, arising from experience and guiding deci- sion-making under uncertainty.2,3 Early caregiving interactions, such as holding, mirroring expressions, and observing subtle cues, not only foster attachment but also shape brain pathways It was a moment in which my intuition, the clinicians’ responsiveness, and the high-stakes context converged into a lived experience of care that was at once clinical, emotional, and existential. 2025 • Developmental Observer • 19 that strengthen intuitive perception.4 Reflection further deep- ens this process, as mothers integrate rational and experien- tial knowledge into an inner path of knowing that reinforces confidence in their gut responses.7 Research demonstrates that parental intuition can detect child illness before clinical signs are apparent, underscoring the value of trusting and articulating these insights in healthcare contexts.1 Together, these practices illustrate that intuitive listening is not mystical, but rather a cul- tivated skill grounded in embodied experience, neurobiological adaptation, and relational attunement. Conclusion Parental and clinical intuition must be repositioned from the periphery of healthcare to its center—not as anecdotal evi- dence but as legitimate, embodied knowledge. In maternal and neonatal care, where uncertainty is frequent and stakes are high, intuition is not a luxury—it is a necessity. By cultivating intuitive competence among clinicians and validating it in parents, we enhance both technical perfor- mance and relational care. The integration of intuitive in- sight into clinical systems has the potential to reduce harm, strengthen trust, and rehumanize care at every level. References 1. Shaw RL, Heath G, Eatough V, Thackeray L. Parental intuition: a phenomenological structure of intuitive knowing in the context of child illness and shared decision-making in healthcare. International Journal of Qualitative Studies on Health and Well-Being, 2015, 20(1). https://doi.org/10.1080/17482631.2025.2491925 2. Byrne A, Massey D, Flenady T, Connor J, Chua WL, Lagadec DL. When nurses worry: A concept analysis of intuition in clinical deterioration. Journal of Advanced Nursing, 2025, 81(8), 4566–4583. https://doi.org/10.1111/jan.16956 3. Sanford S, Schwartz B, Khan Y. The role of tacit knowledge in communication and decision-making during emerging public health incidents. International Journal of Disaster Risk Reduction, 2020, 50, 101681. doi: 10.1016/j.ijdrr.2020.101681 4. Als H, Duffy FH, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV, Warfield SK, Huppi PS, Butler SC, Conneman N, et al. Early experience alters brain function and structure. Pediatrics, 2004. 113(4), 846–857. doi: 10.1542/peds.113.4.846 5. Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: mechanisms and pathways. Obstetric Medicine, 2013, 6(2), 52–57. https://doi. org/10.1177/1753495x12473751 6. McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacology. Stress and the Brain, 2013, 2–18. https://doi.org/10.4324/9781315869865-1 7. Jaworski J. Source: The Inner Path of Knowledge Creation (1st ed.).2012. Berrett-Koehler Publishers. 1st ed. Oakland: Berrett-Koehler Publishers; 2012 During the 36th Annual NIDCAP Trainers Meeting, Emeritus NFI Member and Mas- ter NIDCAP Trainer Kathleen (Kathy) VandenBerg, PhD, was honored for her significant con- tributions to the NFI, NIDCAP, and our community. Kathy was one of NIDCAP’s early pioneers and her contributions have significantly shaped the landscape of newborn intensive care. Kathy was among the first NICU Developmental Specialists, breaking ground in other various roles, including serving as a NIDCAP and APIB Professional, Director of the third NIDCAP Training Center, and Master NIDCAP Trainer. Her commitment to NIDCAP led her to become a founding board member of the NIDCAP Federation Interna- tional, where she helped develop practices that are now integral to our work. Beyond her impressive professional accomplishments, Kathy was an extraordinary friend. She offered unwaver- ing support, encouragement, and thoughtfulness to those around her. Here are message excerpts from individuals whom Kathy touched with her warmth and wisdom. I have never met a more-warm hearted, generous spirit. The energy and wisdom she brought to her work was outstanding and is sprinkled like stardust through everything worthwhile that I have achieved in my own work. (Inga Warren) It didn't matter if you were a conference participant, a mentee, a trainee, a collaborator, or another master trainer- your perspectives were welcomed with a gracious smile, a lis- tening ear, and an unreserved encouragement. (Joy Browne) With Kathy’s teaching close to my heart, I will con- tinue to dedicate myself to nurturing the next generation. (Noriko Moriguchi) Kathy was a dynamic force in the world, who posi- tively influenced those who were fortunate to know her. I am a far better person for knowing Kathy. And will always treasure her in my heart and mind with much appreciation. (gretchen Lawhon) When our son was born, at just 26 weeks, we didn't know what the future would look like. Everything felt so overwhelming. Then this amazing woman, Kathy VandenBerg, introduced us to the NIDCAP program. She gave us hope and strength when we needed it most. And her impact on our family is something we will carry in our hearts forever. (Vicki Batkin Bjornson) Kathy’s inspirational presence and dedication paved the way for advancements in newborn developmental care, leaving a lasting impact on the colleagues and families she touched. She has created an extraordinary legacy developing our compassionate developmental caregiving model and approach. Honoring Kathleen A VandenBerg (1945-2025)