The experiences of mothers in breastfeeding their very low birth weight infants

Title. The experiences of mothers in breastfeeding their very low birth weight infants. Aim. This paper is a report of a study of the breastfeeding experience of mothers of very low birth weight babies. Background. Very low birth weight babies, being born preterm, are at risk for feeding difficulties. Medical complications may prolong their hospital stays and further delay their progression towards oral feeding. Many studies have focused on the benefits of breastfeeding to very low birth weight babies, but very few have explored the breastfeeding experiences of their mothers. Method. Data were collected between 2005 and 2007. In‐depth interviews were conducted during home visits with 31 mothers who breastfed their very low birth weight babies. Following her baby’s discharge from hospital, each mother was interviewed twice about her breastfeeding experience. The data were analysed using qualitative content analysis. Findings. Five themes were identified from the mothers’ reports: wanting to compensate, maintaining motivation and connectedness, needing ‘extra helping hands’, controlling emotions and matching baby’s individual pace. Mothers’ self‐blaming provoked them to breastfeed their very low birth weight babies to compensate babies for the harm caused by them. These mothers learned how to express breast milk and this served as an important vehicle that gradually connected them to their babies. Conclusion. Breastfeeding a very low birth weight baby is a challenging and exhausting experience for the mother. A better teaching protocol for breastfeeding and an improved breastfeeding ethos need to be implemented in the neonatal intensive care unit and special care nursery to support families of very low birth weight infants.     

Mothers' comprehension of terminology associated with the care of a newborn baby

To determine mothers' level of comprehension of terminology used by health care providers when discussing the care of a newborn baby. Sixty patients on a postpartum unit in a general hospital who gave birth to healthy newborns were asked to define 56 terms related to the care of newborn babies that were commonly used by health care providers. Mothers' knowledge of terms was examined by level of education, number of children, previous experience caring for newborns, and age. Analyses of variance results revealed significant differences among mothers for age and level of education. Mothers who were 30 years or older and who had more than a high school education demonstrated the more overall knowledge of terms than younger mothers with less than a high school education. An individual needs assessment must be done for every mother who is a patient on a postpartum unit to determine their learning needs as well as their understanding of common terminology.     

Parents′ experience of living with a baby with infantile colic – a phenomenological hermeneutic study

Scand J Caring Sci; 2011; 25; 317–324
Parents′ experience of living with a baby with infantile colic – a phenomenological hermeneutic study Background: About 10% of newborn babies have infantile colic which means that they cry more than 3 hours per day. The baby’s crying risks disturbing the early parent–child interaction. Objective: This study aimed to illuminate the meaning of being a parent of a baby with infantile colic. Design: An inductive qualitative interview study. Participants and settings: Twenty‐three parents (12 mothers and 11 fathers) seeking help for infantile colic at a Child Health Clinic in south Sweden, having verified in a diary their babies’ crying to more than 3 hours/day, were individually interviewed between March 2006 and April 2007. Parents were selected to ensure variation in age and gender and if they were first‐time parents. Method: Parent’s narratives were analysed using a phenomenological hermeneutic method. Findings: The main theme found was ‘Colic overshadows everything’. Tired and worried parents experienced living in an inferno. Both fathers and mothers suffered with their babies, felt powerless and overwhelmed by strong feelings and neglected their other needs. To get through this period, parents used various strategies to ease their baby’s pain. Parents forced themselves not to lose control, to keep a stiff upper lip and generally to bear up. Sharing the burden was important. In spite of the suffering, they also felt hope, happiness and gratitude that they had a healthy baby. The results were reflected upon in relation to systems theory, attachment theory and a theory of interpersonal aspects of nursing. Conclusion: It is an important task for professionals to empower parents and help them to endure the colic period and to gain higher self‐esteem as parents. By listening to the parents’ stories they can better understand their situation, offer support and increase self‐efficacy.     

Mothers overcoming remorse to care for self and baby: An emerging concept

ObjectivesMothers with substance use disorder (SUD) experience a range of emotions such as feeling ostracized, diminished, and distressed while watching their baby experience withdrawal from substances. Being fully present in the now moment is to trust self to do what is best by moving beyond perceived boundaries to care for self and baby. The process of concept building arose from nursing practice encounters in a special care nursery (SCN) for babies who experienced withdrawal from substances.MethodLiehr and Smith’s 10-phase concept building approach was used to guide the development of this concept. Concept building began with a practice story. The emerging concept was named, core qualities identified, and supported through a literature review. The middle range theory of uncertainty in illness was chosen to serve as theoretical support for the concept. A model was created to provide clarity on the relationships within the concept.ResultA mini-saga was gathered from a mother in the SCN whose newborn had experienced withdrawal from substances. The minisaga follows: Due to the baby’s discomfort and judging eyes of the staff, she was unable to mother her baby. As the baby recovered, she asked for help, comforted her baby, and gained confidence to move beyond perceived boundaries to become the mother she envisioned. Overcoming perceived boundaries to attend to self and baby is trusting oneself to do what is best in spite of feeling ostracized, diminished, and distressed while watching baby withdraw from substances.ConclusionThis concept provides the perspective of mothers with SUD through intermodernism from experiences in nursing practice. The Uncertainty in Illness theory further allows practitioners to gain an understanding of the role uncertainty plays in this unique situation.     

Fathers in neonatal units: Improving infant health by supporting the baby-father bond and mother-father coparenting

The Family Initiative's International Neonatal Fathers Working Group, whose members are the authors of this paper, has reviewed the literature on engaging fathers in neonatal units, with the aim of making recommendations for improving experience of fathers as well as health outcomes in neonatal practice. We believe that supporting the father-baby bond and supporting co-parenting between the mother and the father benefits the health of the baby, for example, through improved weight gain and oxygen saturation and enhanced rates of breastfeeding. We find, however, that despite much interest in engaging with parents as full partners in the care of their baby, engaging fathers remains sub-optimal. Fathers typically describe the opportunity to bond with their babies, particularly skin-to-skin care, in glowing terms of gratitude, happiness and love. These sensations are underpinned by hormonal and neurobiological changes that take place in fathers when they care for their babies, as also happens with mothers. Fathers, however, are subject to different social expectations from mothers and this shapes how they respond to the situation and how neonatal staff treats them. Fathers are more likely to be considered responsible for earning, they are often considered to be less competent at caring than mothers and they are expected to be “the strong one”, providing support to mothers but not expecting it in return. Our review ends with 12 practical recommendations for neonatal teams to focus on: (1) assess the needs of mother and father individually, (2) consider individual needs and wants in family care plans, (3) ensure complete flexibility of access to the neonatal unit for fathers, (4) gear parenting education towards co-parenting, (5) actively promote father-baby bonding, (6) be attentive to fathers hiding their stress, (7) inform fathers directly not just via the mother, (8) facilitate peer-to-peer communication for fathers, (9) differentiate and analyse by gender in service evaluations, (10) train staff to work with fathers and to support co-parenting, (11) develop a father-friendly audit tool for neonatal units, and (12) organise an international consultation to update guidelines for neonatal care, including those of UNICEF.     

The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth

The manner in which a new baby is welcomed into the world during the first hours after birth may have short- and long-term consequences. There is good evidence that normal, term newborns who are placed skin to skin with their mothers immediately after birth make the transition from fetal to newborn life with greater respiratory, temperature, and glucose stability and significantly less crying indicating decreased stress. Mothers who hold their newborns skin to skin after birth have increased maternal behaviors, show more confidence in caring for their babies and breastfeed for longer durations. Being skin to skin with mother protects the newborn from the well-documented negative effects of separation, supports optimal brain development and facilitates attachment, which promotes the infant’s self-regulation over time. Normal babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when skin-to-skin. When the newborn is placed skin to skin with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Hospital protocols can be modified to support uninterrupted skin-to-skin contact immediately after birth for both vaginal and cesarean births. The first hour of life outside the womb is a special time when a baby meets his or her parents for the first time and a family is formed. This is a once-in-a-lifetime experience and should not be interrupted unless the baby or mother is unstable and requires medical resuscitation. It is a “sacred” time that should be honored, cherished and protected whenever possible.     

A Case Study of Teen Parenting

PURPOSE: The purpose of this case study is to demonstrate how the use of the standard nursing languages of NANDA International (NANDA‐I), the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) help a teen mother provide safe care for her newborn. In addition, this study aims to demonstrate how important standardized nursing languages are in documenting the care provided. DATA SOURCES: The data sources for this article are clinical nursing practice, research evidence in the form of care directives from the American Academy of Pediatrics regarding newborn safety and feeding, and the books that provide directions for the use of NANDA‐I, NIC, and NOC. DATA SYNTHESIS: This case demonstrates the use of the nursing process in providing care for a teen mother and a newborn. CONCLUSIONS: Many new mothers, especially teens, are poorly informed regarding normal newborn care and safety upon hospital discharge. For this reason, teen mothers should be referred for nursing assessments in the home environment after discharge. IMPLICATIONS FOR NURSING: This case demonstrates the need for education of all parents prior to hospital discharge and supports the need for home‐based evaluations to ensure the safety of the infant. This case also supports the use of standardized nursing language to document the care provided.     

Providing a Safe Haven: Staff Response to a Simulated Infant Relinquishment in the Emergency Department

Every state in the United States has established laws that allow an unharmed newborn to be relinquished to personnel in a safe haven, such as hospital emergency departments, without legal penalty to the parents. These Safe Haven, Baby Moses, or Safe Surrender laws are in place so that mothers in crisis can safely and legally relinquish their babies at a designated location where they can be protected and given medical care until a permanent home can be found. It is important for health care professionals to know about and understand their state’s law and how to respond should an infant be surrendered at their facility. No articles were found in the peer-reviewed literature that describe a method to evaluate nurse competency during infant relinquishment at a Safe Haven location. This article will describe commonalities and differences among these Safe Haven Laws, responsibilities of the hospital and staff receiving a relinquished infant, and 1 hospital’s experience when running an infant relinquishment drill in their emergency department.     

Patient satisfaction with home-birth care in The Netherlands

One of the necessary elements in an obstetric system of home confinements is well-organized postnatal home care In The Netherlands home care assistants assist midwives during home delivery, they care for the new mother as well as the newborn baby, instruct the family on infant health care and carry out household duties The growing demand for postnatal home care is difficult to meet, this has resulted in a short supply of the most popular day care programme and a level of provision which does not result in adequate services This study acknowledges the patient perspective of maternity home care in order to contribute to its organization The majority (79%) of service centres were willing to participate A total of 1812 (81%) women who recently gave birth to a child responded to a postal questionnaire addressing the quality of care according to five dimensions availability, continuity, interpersonal relationships, outcome and assistant's expertise Almost one-third of the new mothers rated the availability as inadequate while the assistant's expertise was rated positively Postnatal maternity home care is personalized, small-scale, and recognizes childbirth as a life event Furthermore, it is relatively inexpensive and contributes to the satisfaction of recipients     

Interactions of mothers with their newborns in the first half-hour of life

Eight first-time and eight second-time working class mothers were observed interacting with their newborn babies during the first half-hour of life. In all cases the father was present for at least some of this period. The interactions were notable for their passivity, mothers looked for long periods at their babies and engaged in some finger-tip touching of the babies face and head, but they engaged in very little exploration of the babies, few vocalizations and few expressive acts such as kissing. However, the presence of the father was associated with more intense mother-newborn interaction. First-time but not second-time fathers tended to be excluded from interaction with either the mother or the baby at this time. These results are discussed in the light of current thinking on mother-newborn bonding and the role of midwifery staff in promoting that bonding process.     

Novel use of Facetime in supporting maternal-infant bonding

The initial bonding experience between a mother and her infant has been shown to have a positive effect on neurobehavioural responses. Many women often wait several hours before seeing their baby for the first time either due to caesarean section delivery or peripartum complications. A technology solution utilizing Face Time can improve mothers' experience by allowing them to see their babies earlier. The technology allows the mother to see her baby in real time and the opportunity for the neonatal nurse to answer questions about her baby's care and well-being. The results showed that the use of i Pads led to a significant reduction in the time mothers were able to see their babies for the first time.     

A challenge in spite of acceptance - how mothers of newborn babies with a "cleft" experience the transition from the hospital back home

There is almost no empirical data about how mothers of newborn babies with a cleft lip and/or palate manage the transition from the hospital to home. This qualitative study therefore focuses on the experiences of mothers of newborn babies with a cleft lip and palate. Two problem-oriented interviews were conducted with five women. Using a qualitative content analysis, one main category and four sub-categories were defined. The main category called "receive the right kind of help" shows that the women depended on different types of support, concerning various topics from the diagnosis to everyday family life. This is reflected in the sub-categories: a) it is the way it is, b) sudden disappearance of the child, c) time-consuming and difficult nutrition and d) master everyday family-life. These sub-categories display the experiences of mothers of newborn babies with a cleft lip and palate during the transition from hospital to home and point to the big challenge of these mothers in transition. Most important is that health professionals seek to better understand mothers' experiences in this important phase in order to optimize both the support in hospital and outpatient facilities.     

Attachment between father and premature baby in kangaroo care in a neonatal unit of a public hospital

BackgroundPrematurity rates are on the rise; every year, thousands of parents face having their babies prematurely. Preterm labor breaks the nature of the attachment between the parents and the baby. The kangaroo method favors interaction and helps to establish attachment between the father-baby dyad. The father often does not have the same opportunities as the mother to participate in the baby's care while staying in the neonatal units.AimsAnalyze fathers' attachment with their babies in a neonatal kangaroo unit.Study designWe conducted a cross-sectional study with 32 fathers of premature babies hospitalized in a neonatal unit. We use the paternal postnatal attachment scale. It is an instrument that measures attachment in three factors: patience, tolerance, and satisfaction; Pride and affection; interaction and transition to parenthood.ResultsAttachment was affected by factors such as the type of prematurity of the baby, the residence of the father, the type of birth, and the fathers who made skin-to-skin contact. There were no significant differences in attachment scores for the father's age, the baby's gender, or the father's education level.ConclusionFathers who performed skin-to-skin contact have higher attachment scores. Fathers are in a complicated situation as they do not have a paternity leave equivalent to that of mothers, and by the economic burden of having a premature baby.     

The transition home of extremely premature babies: An integrative review

Taking a premature baby home after an often-protracted period on the neonatal unit can be stressful for parents and they are often confronted with an unexpected reality. The transition to motherhood and parenthood has occurred in the neonatal unit, under the watchful eye of neonatal nurses. When the baby goes home, parents are expected to take on the full-time caregiving role of a baby who may require around the clock care with medications, home oxygen, feeding issues and monitoring. The level of preparation for the transition home of the premature baby can impact on how the family survives and thrives. It is not surprising that parents may find this challenging because the growth and development trajectory of extremely premature babies can be markedly different from a term infant requiring tailored support. This article is an integrative review of the literature focusing on parents’ experience of transitioning home from a neonatal unit with a premature baby. Six themes were identified, and an analysis is presented: namely, transition, unique needs of premature babies, discharge preparation and readiness, discharge learning content, maternal mental health and the role of the neonatal nurse in transition.     

Eye opening of the newborn at and up to 20 minutes after birth

Early eye contact between mother and baby is considered important in the attachment process between mother and baby. How soon after birth is it possible for eye contact to occur? How soon after birth will a baby open his eyes spontaneously? Where is the baby physically at that time? Is hospital labour ward routine conducive to early eye-to-eye contact between mother and baby? Discussing these questions with midwifery colleagues, it became apparent that we were unable to answer with any degree of certainty, the question ‘How soon after birth will a baby open his eyes spontaneously?’ It was felt that ‘most babies open their eyes at or very soon after birth’. How soon was ‘very soon’? and did all babies open their eyes soon after birth? Were there any observable influencing factors? If so, what were they? In this study of 104 babies, 30 babies opened their eyes at birth, and the remainder, except three, opened their eyes ranging from within 1 minute of birth to within 20 minutes of birth (20 minutes being the time limit set for the study). Some babies were observed to open their eyes momentarily only the very first time, keeping their eyes open longer subsequently.     

对住院新生儿家属实施健康路径教育的效果初探

目的:通过对住院新生儿家属实施健康路径教育,使其积极配合护理工作,提高新生儿护理质量。方法:选择我院2006年6月~2007年6月住院新生儿100例,将其随机分为对照组与观察组,每组各50例。对照组采用常规健康教育方法;观察组按照我们在常规健康教育基础上编写的新生儿健康路径材料进行教育。结果:观察组健康教育达标率为92.0%,对护理工作的满意度为98.0%;对照组健康教育达标率为78.0%,对护理工作的满意度为86.0%,两组比较差异具有非常显著统计学意义(P<0.01)。结论:通过对患儿家属实施健康路径教育,提高了患儿家属照料新生儿的能力,促进和改变了健康行为,减轻了患儿的痛苦,使护理工作质量明显提高。     

Maternal and neonatal elimination of amobarbital after treatment of the mother with barbiturates during late pregnancy.

Plasma half-lives of amobarbital were determined in newborn children of 10 mothers who had been treated with barbiturates for hypertension in pregnancy for 6 to 42 days prior to delivery. Five mothers had received amobarbital, 200 mg daily, and 5, phenobarbital, 60 to 180 mg daily. Half-lives in 7 of the babies ranged from 16.6 to 49.4 hr, comparable to those previously reported in babies of mothers who had received only a single dose of amobarbital. Thus there was no evidence of induction of amobarbital hydroxylation in these children. Two babies who had a greater than normal rise in serum bilirubin had longer half-lives (86.1 and 117.7 hr). In 1 baby whose mother had membranous glomerulonephritis, plasma amobarbital concentration did not significantly change over the period of the study.