Helping parents of pre-term babies to cope

The trauma of preterm delivery on the family unit cannot be underestimated. By Trudi Mannix

Following the birth of a pre-term baby, parental stress levels are high. Emotions are mixed; parents are grateful that their baby is alive, but at the same time they face the fear that their baby will die, or suffer permanent long-term damage.

Mothers may feel guilt that the pregnancy was not carried to term, and both parents feel a sense of powerlessness which leads to a loss of confidence in their ability to provide care for their baby.

The cuts and bruises, colour, size and weak appearance of the infant does not compare to the image of the baby that parents have built up in their minds, and is source of distress to mothers in particular.

The NICU environment is alien, with constant noise from ventilators, monitors and alarms. Parents feel added stress when they don’t know what is happening to their baby, and when they receive conflicting information.

For up to two years after delivery, the long-term effects of this stress may manifest in depression, post-traumatic stress syndrome and mental illness, with effects on the infant’s long-term cognitive and psychomotor development.

In addition, early disruptions to bonding between parents and their pre-term infant disrupts parent-infant interaction and adds pressure to the marital relationship.

Neonatal nurses are at the forefront of best practice around the world in helping parents cope with this stress.

At international centres of excellence, neonatal nurses are working with their medical and allied health colleagues and families to intervene early to reduce the stress that parents feel when a pre-term delivery is imminent and babies are admitted to the NICU. Some examples include:

• The COPE (Creating Opportunities for Parent Empowerment) program By educating parents about their pre-term baby’s appearance and behaviour, parents learn the best time to interact, and how to interact with their baby in a developmentally sensitive way. Randomised controlled trials of the COPE Program have shown that parents subsequently gain confidence, feel less helpless and more empowered, and this reduces their stress levels and rates of depression.

• The FIC (Family Integrated Care) program In this intensive parent-focused program, one parent acts as the primary giver for eight hours a day, and provides all care except administering medications and IV fluids, and adjusting ventilation requirements. Neonatal nurses stand alongside parents offering continual support, education and coaching.

• The March of Dimes Family Support Program (FSP) Former NICU families provide information (in the form of a parent care kit) and offer one-on-one support to parents, siblings, grandparents and the extended family. The parent care kit contains information about the staff that work in the unit, common procedures and equipment, and the likely conditions that effect pre-term infants. The FSP also provides professional development for staff. Parents also participate in their baby’s care and through this positive parental interaction, bonding is improved, and consequently there are promising long term impacts on the infant’s cognitive development.

• The NIDCAP (Neonatal Individualised Developmental Care & Assessment Program) Following systematic observations of a pre-term infant at 7-10 day intervals for 10-15 minutes before, during and after a procedure, an individualised care plan is formulated. How the infant responds to the procedure is assessed according to their colour, heart rate, posture, facial expressions and these observations help to determine their capacity to interact. Changes can then be made to the environment, the timing of care, aids for self-regulation etc. The results are also used to teach parents to interact more successfully with their baby. The NIDCAP has been shown to have lasting beneficial effects on brain function into school age.

• The Maternal-Infant Transaction program (MITP) comprises seven one-to-one sessions conducted in the week before hospital discharge and four home visits within the next three months. Training sessions are designed to enhance the quality of mother–infant interaction by teaching the mothers of low-birth-weight infants to be more sensitive and responsive to their babies’ physiological and social cues. By structuring all aspects of the environment (including interactions) to suit the infant’s ability to cope, the MITP aims to help the infant to never (or rarely) be allowed to become so stressed as to be disorganised, with long-term positive impacts on the infant’s cognitive development.

Aspects of these programs have been implemented in Australia with varying success. Neonatal nurses have a responsibility to find out more about these examples of best practice, and work together with their neonatal colleagues to translate these potentially simple, clear and effective interventions into national practice.

High quality large research studies in the area of reducing parental stress in neonatal units need to be undertaken to further develop and test these interventions.

Dr Trudi Mannix is an academic in the School of Nursing and Midwifery at Flinders University in Adelaide.

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