Mothers and Babies Should Be Together. Carol Bartle NUMB Launch Hamilton, New Zealand April 2005.

Mothers and Babies Should Be Together.

Carol Bartle‘NUMB’ LaunchHamilton, New Zealand April 2005

Neonatal Intensive Care in the 1970s Increased understanding of neonatal

diseases and better technology Development of neonatal intensive

care units Improved survival rates Parents as passive observers

Carol Bartle April 2005

NICUs in the 1980s

Studies showing the importance of parental involvement and participation appeared.

Gradual changes to try and take account of the emotional support of parents


NICUs 1990s ‘Family Centred Care’ models – adaptation

uneven and site dependent Rooming in facilities for NICU mothers

variable and resources variable depending on site of care

Qualitative research studies appeared on mothering experiences within NICUs

‘Kangaroo Mother Care’ promotion. Uneven adaptation and site dependent. ‘Token’ KMC more likely to be implemented.


NICUs in the year 2000 and beyond… More modern NICUs have been developed to

take account of the needs of families. This has generally involved providing a limited number of ‘rooming-in’ beds for mothers with babies in the NICU.

The welcome development of ‘rooming in’ in N.Z. NICUS has not yet progressed into the ultimate in family care which is single room NICUs with family rooming in facilities. These single room NICUs have been developed in the U.S.


Neonatal Intensive Care

Future NICU development needs to take into account the wishes of mothers and families who wish to stay with their preterm and unwell babies.

Research indicates that babies do better when their mothers are with them.

The environment needs to be designed to meet the needs of staff working in the NICU also. Parent needs and staff needs can be compatible.


What Parents Need…

Reassurance that the care is excellent and trust in the NICU staff

Being close to the baby. NICUs facilitating not blocking mother/baby/family togetherness

Information. Regular updates, primary nursing, personalised and not prescriptive advice, access to medical and nursing staff

Comfort and support. Facilities such as kitchens laundries and sibling care services. Support services. Parent liaison staff


Neonatal Intensive Care needs… Single room NICUs for all others who

wish to and/or are able to stay Privacy for families Communal family lounge for parents to

meet Sibling Care programmes and child care

on site and close to the NICU Breastfeeding rooms Library, video and internet accessCarol Bartle April 2005

The Humane Neonatal care Initiative(Professor Adik Levin, Tallin Children’s Hospital, Estonia)

Facilitating maximum contact of mother and baby

Minimum contact between babies and staff Reducing psychological stress in mothers Maintaining the ‘psychological’ umbilical

cord Rooming in 24 hours a day –Tallin policy

introduced in 1994 Humane rights of the baby are not only to

be surrounded by highly qualified medical staff and good apparatus but also to be with his or her mother and father as well


“Being Thoughtful and Careful…”(Priday 2003) “Never have I encountered doctors, nurses or

midwives who wished to cause discomfort for mothers: all believe their practices are essential for the most beneficial outcomes for mothers and babies” (Beverley Chalmers 1997).

The scientific and technological NICU requires a complimentary culture of caring for parents to add a much needed psychosocial element. Keeping mothers and babies together provides a ‘scaffold’ for vulnerable babies and supports the vulnerable family within this environment.


Kyra Marie Landzelius., Culture, Medicine and Psychiatry, 2003(27). 32 months of observations, interviews and

informal conversations with 124 mothers in a NICU

Fragment from an interview “ This baby is the centre of my being, everywhere I go, everything I do, when I’m waking, dressing, eating, whatever, it doesn’t matter, he’s with me, in my thoughts, in my heart, hey he is my heart, he’s in here (mother taps her chest)”.


Comments from Mothers One common symptom emerged in mother’s

accounts in Landzelius. Anxieties about ‘bonding’ with their NICU babies. Comments included : “Hindered contact”, “Prevented togetherness”, “Inhibited expression”, “Stole their intimacy”.

Broeder (2003). Challenges for mothers were identified. Trying to remain connected with their babies and “getting to know” their babies when nurses were the primary caregivers.


Nystron & Axelsson., 2002 Separation from the baby caused emotional

strain and anxiety (study involved full term infants in the NICU for between 2-10 days)

Mothers felt like “outsiders”. Despair, homelessness, powerlessness, disappointment

Despair was prominent Anxiety that babies would be harmed by the

separation All mothers expressed a desire for closeness

with their babies and joy was inspired by moments of contact


Other Research: How mothers ‘survive’… “Learning and Playing the Game”.

‘Watching, listening, being polite, remaining pleasant, holding ones tongue, not stepping on toes, not complaining, not using ‘bad’ words, making sacrifices, jumping through hoops’ (Fenwick, Barclay & Schmied 2002)

Stainton et al., (2001) found that involving parents in the care of their baby was the most uneven staff adaptation in their NICU project to evolve a developmental care culture.


More Research…

Loss of parental role is the major stressor for parents in the NICU (Holditch-Davis & Miles, 2000; Spencer, 2003)

Mother-baby separation was the most stressful issue (Affonso, Hurst, Mayberry, et al.,1992; Miles, Wilson & Docherty, 1999)

Separation from the baby was the worst feature

(Redshaw & Harris, 1995)Carol Bartle April 2005

Separation and Stress (Kanitz et al., 2004) Stress in the form of intermittent maternal

deprivation produces persistent changes in physiology and behaviour in rats and monkeys. It is well known in studies of rodents and monkeys that isolated infants become progressively lethargic and show rather passive patterns of behaviour (mental despair/stress induced sickness -often considered an animal model for human depression)

In the human, early life experience may modulate stress responses and coping mechanisms, with long term implications for emotional health and cognitive function

Piglets exposed to intermittent maternal contact showed a significant decrease in locomotion, increased inactivity and decreased reactivity patterns.


The Effects of Stress Fear Exhaustion Vulnerability Role conflicts Depression, anxiety, PTSD Communication problems – parents,

parents/staff. Vigilance and hypersensitivity Compromised immune system Increased problems with expressing

breastmilk and breastfeedingCarol Bartle April 2005

Women’s Words (Bartle 2005)

“Well every time your milk drops you look at it and go,’ Oh my God I’m failing’, because you can’t really be a mum up here, it sort of compounds it I suppose and you do feel like you’re just hopeless really…”

“You can just detach yourself from this place completely when you go home. I don’t have babies, I could pretend that I don’t have them sort of thing. It makes you worry. I mean I’m their mum and I don’t care whether I’m here or not. It they’re stuck in here and you’re not allowed to have cuddles or anything you might as well be at home”.



“ It’s hard coming up here all the time you know three or four times a day and then to sit down on a chair and think, Mmm, I’ve got nothing to do except watch a baby sleep you know, you think ‘well this was a wasted visit’ ”.

“ They told me I had to put her back. She needed to go back and have a rest or something but we were both having a sleep. Well I thought that they grow when they are asleep and it would be just like when they were inside wouldn’t it?”



“I don’t know if he [baby] knew who I was you know. I was just there feeding him along with other people doing things to him”.

“There’s the thing that someone has assumed ownership of your baby and they assume that you don’t have your baby’s best interests at heart which is bizarre really”.


Contact: The Missing Piece of the NICU Care ‘Jigsaw?’ Facilitates empowerment of the mother and baby Meets maternal needs- giving pleasure, reducing

anxiety, depression and fatigue. Positive spin offs for the family

More breastfeeding opportunities - less restricted, robust breastmilk supplies

More responsive, less stressed babies Learning the early baby cues and being supported to use

them rather than a total reliance on ‘clock watching’ ‘Knowing’ your baby and knowing how important you

are to your baby Resting with your baby - as opposed to being sent home

for a rest and then worrying about your baby and NOT resting!


Kangaroo Mother Care Kangaroo Mother Care returns the baby back to

the maternal environment Incorporates the benefits of touch, maternal

sounds and visualising the maternal face. Also adds the rhythm of the mother’s breathing . All important for neurological development

Provides a shield AGAINST over-stimulation KMC can reduce depression and increases

mothering confidence, competence, and connectedness (Oxytocin)

Parental, lactational, developmental, physiological benefits


Individual Rooms in the NICU: An Evolving Concept (Dr R White) Appropriate environmental stimuli for each baby Increased privacy and accessibility for families Designs considerate of staff support issues.

“ The greatest resistance to the single room NICU is based on the perception that it would require more staff because they could not observe all neonates at all times. It is imperative that the single room NICU use communication technology to mitigate the perceived need for more staff” (Nareesh Mathur)


Mother’s Arms – the past and future locus of neonatal care? (Dr R White 2004) “With the advent of neonatal intensive

care medical professionals inserted themselves between the baby and its family”

“Family-centred care restored the family’s right to full access to their baby but medical professionals still view the infant as a solitary individual who sleeps most of the time in a bed”.


Mother’s Arms – the past and future locus of neonatal care? (Dr R White 2004) “Future NICU design should recognise that

the baby must spend most of its time in its mother’s arms to get the full benefit of her sensory environment”

“NICU’s must therefore be planned to facilitate this extended proximity as much as possible (i.e. not just providing for parents at the bedside with the bed as the locus of care but transforming the predominant locus of care from the bed to the parents’ arms)”


Mother’s Arms – the past and future locus of neonatal care? (Dr R White 2004)

“Designing our units to facilitate this interaction will not assure that it will always occur but it will guarantee that we have not created permanent structural features that interfere with this crucial relationship”.

Clinics in Perinatology 2004, June; 31(2),383—397.


Acknowledgments from Carol Bartle

Canterbury Medical Research Foundation for research funding

The women who participated in my research My thesis supervisors Dr Kath Ryan & Dr

Judith Duncan. University of Otago, Dunedin, New Zealand.

La Leche League New Zealand for all their support

Ongoing support and inspiration from my friends Rea Daellenbach & Carol Thomas

The women involved in NUMB, particularly Donna Booth, for continued enlightenment.


Mothers and Babies Should Be Together. Carol Bartle NUMB Launch Hamilton, New Zealand April 2005.

Documents

nicu babies

nicu mothers variable

family care

nicu staff

mothers accounts

wishes of mothers

days mothers

vulnerable babies