From the delivery room to the neonatal intensive care unit—Mothers' experiences with follow-up of skin-to-skin contact after premature birth
Introduction
According to the World Health Organization, approximately 15 million children are born premature each year (WHO, 2012). Skin-to-skin contact (SSC) is assumed to reduce some of the negative consequences of preterm birth (Charpak et al., 2005, Conde-Agudelo and Diaz-Rossello, 2014).
Based on new knowledge of the benefits, parenting in the context of intensive care has been encouraged (Als and McAnulty, 2011). Therefore, SSC has been implemented to some extent in the neonatal intensive care units (NICUs) in all the Nordic countries over the last few years (Olsson et al., 2012).
Although qualitative studies reporting on mothers' experiences are relatively scarce, previous studies indicate that several factors must be considered when changing routines regarding increased parental involvement, including SSC. Of significant importance are staff attitude (Kymre, 2014, Olsson et al., 2012, Valizadeh et al., 2013), organization of care, and the physical environment in general (Baylis et al., 2014, Blomqvist et al., 2013, Flacking et al., 2013, Guillaume et al., 2013, Shahheidari and Homer, 2012, Sjetne et al., 2013, Wallin et al., 2005, Wigert et al., 2010).
The United Nations Convention on the Rights of the Child (UNCRC) states that children have the right to have a parent with them during hospitalization (United Nations, 1989). Additionally, Norway has national legislation that confirms these rights (Ministry of Health and Care Services, 1999). Both legislations also apply to preterm infants. Nevertheless, premature birth often leads to immediate separation regardless of the medical state of the child. Some NICUs also have visiting restrictions, which actually contradicts these legislations (Olsson et al., 2012).
Norway is a rather small country by a global scale, with approximately 60,000 births annually, of which about 6% are premature. At the University Hospital in Trondheim, the number of births is approximately 4000 annually (Medical Birth Registry of Norway, 2009–2012). About 80 of these premature births require hospitalization at the hospital's NICU. This NICU is relatively new (opened in 2006), but it is not physically designed for continuous SSC or parental presence around the clock. Nevertheless, the declared policy has been to stimulate parental presence and SSC “as much as possible”. Consequently, there are routines for staff training in SSC. For the parents, the unit provides a “Kangaroo leaflet,” in addition to verbal information, that points out the advantages of SSC.
In 2007, the unit implemented a new routine in cooperation with the maternity ward (MW) for delivery of healthy, moderately premature infants (GA 320–346). Replacing the former routine of separation and transfer to the NICU in an incubator, the infant is now placed skin-to-skin with the mother after a quick assessment. If the medical state is stable, the infant stays on the mother's chest for 1–2 hours. A midwife is responsible for the mother's state, and a NICU nurse observes and monitors the infant.
Medical security had been the main reason for the former practice. Therefore, a quantitative study focusing on this issue was initiated at the study hospital related to the new routine, which indicates that SSC immediately following delivery is safe for these infants (Kristoffersen et al., 2016).
This study was later enlarged with a qualitative component, and not all results from this expanded study have been published yet. The aim of the present part of this study was to explore mothers' experiences with SSC during hospitalization following the hospital's change in delivery routine.
Section snippets
Setting and sample
The inclusion criteria for this study were mothers of healthy moderately premature infants (GA 320–346) who had experienced immediate SSC after delivery and lived within an hour's drive from the hospital. Letters of invitation were sent to mothers who complied with the inclusion criteria (N = 22) as they became available after their deliveries, and eleven accepted the invitation. Two of the mothers did not show up to the appointment. Consequently, nine mothers altogether, aged from 22 to 43
Results
The overall results indicated that the mothers expected and wanted to continue SSC on a larger scale than they experienced to be possible in the NICU and MW. The following main themes emerged from the analysis: importance of staff competence and support, the mothers' desire for an overall focus on health, and physical/organizational barriers to SSC at the NICU and MW.
Discussion
The results of the study emphasize how a variety of factors such as staff attitude and physical environment influence a mothers' practice of SSC when a premature child is hospitalized. Promoting factors, as well as barriers, were identified. Naturally, infant safety must always be the primary criterion for the use of SSC. Nevertheless, the care of the premature infant is the basis of lifelong parenting, so it is essential to support normal development and bonding by involving the parents as
Conclusion and implication for practice
This study presents an overall focus on promoting health in premature care, and an early onset of SSC facilitates this focus. Furthermore, separation of the mother and her infant is described as very painful, contradicts legislation, hinders SSC, and should therefore be avoided as much as possible. Consequently, to secure adequate care for both and be in accordance with the law as well, our study points out some benefits of caring for the mother and the premature infant in the same ward.
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