Effects of Prematurity on Bonding A Study at KATH MBU

Group Members

Appiah Boateng Edward

Agyemang Serwaa Linda

Antwi Opoku Ernest

Introduction Premature infants have an especially hard time dealing with the

transition from their intrauterine environment into the world because they many times are not yet adapted or able to live outside the womb.

The Neonatal Intensive Care Units (NICUs) are designed to meet the medical needs of these infants by providing oxygen, gastric tubes, incubators, etc.

Bonding is the formation of a mutual emotional and psychological closeness between parents or primary caregivers and their newborn child (Linwood, 2006).

Background to the Study

Introduction

Complications may alter bonding somehow. Mother or baby may spend some time in intensive care, as in preterm delivery, and mother or father may be put off by the amount and complexity of equipment (Weiss, 2008). The separation that is brought about as a result of the baby’s admission to the NICU tends to contribute greatly towards delayed bonding.

9.3% of births in Korle Bu are preterm (Nkyekyer, Enweronu-Laryea, and Boafo 2003)

Background to the Study

Year

Deliveries 2005 2006 2007

Total 10743 10015 12318

Preterm 1343 1094 1200

% Preterm 12.50% 10.92% 9.74%

Background to the Study Cont’d

Preterm deliveries at KATH from 2005 to 2007

(Courtesy Reproductive Research Unit, Obstetrics and Gynecology Department, Biostatistics Unit – KATH, 2008)

Introduction

Background to the Study Cont’d

Studies of newborn monkeys who were given mannequin mothers at birth showed that, despite the efforts of the baby monkey to get a response through holding and touching the mannequin, the lack of a parental response caused stunted development, sadness, and failure to thrive in the young monkeys. Scientists, therefore, suspect that lack of bonding in human babies causes similar problems. (Homeier, 2005)

Prolonged hospital care intrudes upon maternal interactions and mother-infant bonding, where interactions take place in a newborn intensive care unit, often separating mothers and their infants for longer periods of time, resulting in limited opportunities for mothers to feed or nurture their preterm infants (Goldberg & Divitto, 2002).

Introduction

Incubators and medical care, necessary for the infant’s survival, is accompanied by physical separation between the preterm infant and his or her parents. The immature preterm infant is not able to interact with the parent in the same way as the healthy infant, which includes sustained eye contact and auditory orientation to the parents’ voice. (Als, Butler, Kosta, McAnulty 2005).

Medical procedures alone have been estimated to account for the majority of social and physical contact a premature infant endures whereas, mothers' account for a mere 14 percent (Goldberg & Divitto, 2002).

Background to the Study Cont’dIntroduction

Feelings of anxiety, and fear that their infants will not survive or survive with disabilities, as well as guilt, anger and helplessness may influence negatively on the process of bonding and may be further enhanced by the preterm infant’s weaker signals and lower alertness and responsiveness. (Als et al, 2005; Eckerman, Oehler, Medvin, Hannan 1994; Minde, Whitelaw, Brown, Fitzhardinge 1983)

American pediatricians John Kennel and Marshall Klaus pioneered scientific research on bonding in the 1970s. They experimented with giving mothers of both premature and healthy full-term babies extra contact with their infants, immediately after birth and in the few days following birth. Mothers with more access to their babies in the hospital developed better rapport with their infants, held them more comfortably, and smiled and talked to them more often (Kennel and Klaus, 1998).

Background to the Study Cont’dIntroduction

Kangaroo Care (also Kangaroo Maternal [Mother] Care or Skin-to-Skin Contact and Breastfeeding) is a method used to restore the unique mother-infant bond following the sudden separation during the birth experience particularly in premature births (Kirsten, Bergman, & Hann, 2001).

Background to the Study Cont’dIntroduction

In KATH, about 9 – 12% of babies delivered are premature and many of these preterm babies spend an average of 5.7 – 8.6 days in the Mother and Baby Unit (MBU) where they receive intensive care. Others spend weeks or months at the MBU based on their general condition. While there, they are separated from their parents. Mothers have scheduled visits during which they express breast milk for their babies. (Child Health Directorate, Biostatistics Unit, KATH, 2008)

The problems, then, are: do mothers at the Komfo Anokye Teaching Hospital’s Mother and Baby Unit (KATH MBU) feel close to their preterm infants? Do the care patterns at the MBU affect the bonding process?

Problem StatementIntroduction

It is evident that preterm infants may need to spend their first few days of life in the Neonatal Intensive Care Unit (NICU). It has also been established that bonding may be promoted by contact between parents and their infant (Salariya 1990). This study seeks to identify how admission of preterm babies to KATH MBU affects the bonding process between the parents and their preterm infant within the period of admission into the MBU.

Furthermore, recommendations, based on findings, would be made to the appropriate body or authority.

Purpose of the StudyIntroduction

General This study seeks to identify how admission of preterm babies

to KATH MBU affects the bonding process between the parents and their preterm infant within the period of admission into the MBU.

 

Specific To assess parents’ knowledge on preterm delivery. To identify common concerns of parents of preterm infants

while on admission. To identify care patterns of preterm infants at the KATH

MBU.

Objectives Introduction

Study Area Mother and Baby Unit, Komfo Anokye Teaching Hospital

Study Population forty mothers of preterm infants on admission who had spent,

at least, three days in the unit. Data collection period was from 5th to 20th of April, 2008.

Selection of the mothers was by convenience sampling method.

Exclusion from the study was mothers of preterm infants with other congenital abnormalities such as cleft palate, hare lip, etc.

Study Design Non experimental study design Cross-sectional study design

Data Collection Tools Questionnaires Pen/pencil Notebooks /exercise books

 Data Collection Techniques Pretesting Questionnaires were administered to mothers of preterm infants

included in the study. Those who could read and understand answered the questionnaires themselves. Those who could not read and understand the questions were guided through the process by the interviewer.

Sessions were carried out for various subjects on various days as to get the targeted number of respondents.

Data was also gathered through participatory observation of daily routine procedures/activities in the unit.

Statistical Package for Social Sciences (SPSS) software was used in the analysis of the data.

Causes Frequency PercentCumulative

Percentfetal abnormality 1 2.5 2.5

multiple gestation 1 2.5 5.0 medical conditions

in mother15 37.5 42.5

premature rupture of membranes

19 47.5 90.0

others (enema, strenuous activities, etc.)

4 10.0 100.0

Total40 100.0

Mothers Knowledge on the Cause of their Current Preterm Births

Feelings Frequency PercentCumulative

PercentScared 9 22.5 22.5

mixed feelings

19 47.5 70.0

Guilty 2 5.0 75.0 Lonely 2 5.0 80.0 Sad 8 20.0 100.0 Total 40 100.0

Feelings of Mothers about Baby's Admission to MBU

Time Frame Frequency PercentCumulative

Percent3-5 hours 5-7 hours

1 2.5 2.5

39 97.5 100.0

Total 40 100.0

Time Spent by Mother and Baby Together in a Day

changing diapers,cleaning babies, holding

baby skin to skin

changing diapers andholding baby skin to skin

changing diapers and

cleaning babieschanging diapers

Activities

20

15

10

5

0 1

17

5

17

Other Activities Mothers do for Babies on Admission

Frequency

Relationship Frequency PercentCumulative

PercentWithdrawn 1 2.5 2.5

Close 37 92.5 95.0 Incompetent 1 2.5 97.5 Helpless 1 2.5 100.0 Total 40 100.0

Relationship between Mother and Baby at the Time of Data Collection

yesno

Mothers’ satisfaction

60

50

40

30

20

10

0

45.0%

55.0%

Mothers Satisfaction with Information Provided by HealthcareProviders

Percentages

Feelings Frequency PercentCumulative

PercentScared 14 35.0 35.0

Conducive for neonatal care 26 65.0 100.0

Total 40 100.0

Mothers Feelings about NICU Environment

• The study by Kennel and Klaus (1998) revealed that mothers with more access to their babies in the hospital developed better rapport with their infants, held them more comfortably, and smiled and talked back to them more often.

• Majority (92.5%) of the mothers felt close to their babies and 90% of them were comfortable relating to their babies.

• Four (10%) of the mothers were not comfortable relating to their babies because of the equipment that was connected to them (babies). These hindered them (mothers) from performing a range of activities, such as holding babies in their bosom, cradling their babies in their laps, etc.

• Eighteen (45%) of the mothers in this study practiced skin-to-skin contact with their babies. These mothers displayed feelings of confidence, competence, satisfaction and comfort. Such feelings gave them a positive attitude towards the care of their babies.

• Skin-to-Skin Contact restores the unique mother-infant bond following the sudden separation during the birth experience particularly in premature births (Kirsten, Bergman, & Hann, 2001).

• Pictures and posters on KMC had been pasted on the unit. Mothers had been well educated on KMC and its benefits for both mother and baby.

• However its practice was not very common. Reasons given were that the babies’ conditions and equipment connected to them would not permit mothers to practice KMC.

• Inadequate information provided by the healthcare team to the mothers during such periods of emotional disturbances may increase the anxiety and fears of the mothers. Twenty-two (55%) of the mothers for this study were not satisfied with the information provided by the healthcare team on the condition of their babies. According to Mok and Leung (2006) mothers of preterm infants desire more information and supportive communication. Most parents do not want to have extensive and complex explanation. Parents just want to be informed and be able to ask questions, which make them feel included (Gordin and Johnson, 1999).

• Fourteen (35%) of the mothers for this study said they were scared of the MBU. Several studies by Shields, Kristensson-Hallstrom, O'Callaghan (2003), Bass (1991) and Miles (1989) showed that the environment at the NICU is experienced as a stressor for parents of preterm infants, supporting the above finding of this study. However, majority (65%) of the mothers who participated in this study did not talk much about the high technology environment at the MBU but saw the technology as important for giving the infants the best care as possible.

The study, “Effects of Preterm Birth on Bonding: A Study at KATH MBU”, revealed the following;

Admission of a preterm infant into the MBU has no direct negative effect on the bonding process.

Many mothers attributed the cause of their preterm delivery to physiological processes and, as such, did not blame themselves.

There were social support systems within the unit (relationships between mothers and the healthcare team and that among mothers) which helped to allay anxiety in mothers.

Mothers spent between 5 – 7 hours with their babies in a day within which they breastfed and performed other activities for them. Mothers testified that the time they spent with their babies was enough for them.

Fathers were not directly involved in the care of their babies except payment of hospital bills and other expenses.

Kangaroo mother care which was practiced by minority (45%) of the mothers increased their confidence and competence in caring for their babies.

Many mothers were not satisfied with the information provided to them by the healthcare team about the condition of their babies.

Fathers should be assisted to be actively involved in the care of their preterm babies. Infection prevention measures such as the use of sterile gowns, washing of hands before touching babies, etc. should be put in place so that fathers can hold and perform other activities for their babies whenever they Fathers should be assisted to be actively involved in the care of their preterm babies. Infection prevention measures such as the use of sterile visit.

Photographs of some preterm babies that have ever been on admission, at birth and after some years of discharge should be pasted in the unit. This would give new preterm parents the assurance that their babies would survive no matter their condition as at the time of admission.

There should be measures to promote the effective implementation of kangaroo mother care. One of such measures is that a KMC unit should be established so that babies that are about to be discharged can spend not less than 24hours with their mothers there. KMC would then be practiced under the supervision of nurses and other healthcare professionals.

Parents just want to be informed and be able to ask questions, which make them feel included (Gordin and Johnson, 1999). Therefore, information on condition of babies should be explained in simple and clear terms to mothers and they should also be encouraged to ask questions.

References 

1. Als H, Butler S, Kosta S, McAnulty G (2005). The Assessment of Preterm Infants Behaviour (APIB): Furthering the Understanding and Measurements of Neurodevelopmental Competence in Preterm and Full-term Infants. In: Kleberg A (2006). Promoting Preterm Infants’ Development and Mother Child Interaction, Karolinska Institute, Stockholm.

2. Bass L.S. (1991). What do Parents need when their Infant is a Patient in the NICU? Neonatal Network 10 (4) pp. 25–33

3. Eckerman CO, Oehler JM, Medvin MB, Hannan TE (1994). Premature Newborns as Social Partners before Term Age. In: Kleberg A (2006). Promoting Preterm Infants’ Development and Mother Child Interaction, Karolinska Institute, Stockholm

4. Goldberg S and Di Vitto B (2002). Parenting Children Born Preterm. In: Bell M (2007). The Effects of Prematurity on the Social and Emotional Development of School Age Children. Available online at www.prematurity.org/research/prematurity-effects1.html (accessed on 2nd January, 2008)

5. Gordin P. and B.H. Johnson (1999). Technology and family-centred perinatal care: conflict or synergy? Journal of Obstetric, Gynaecologic and Neonatal Nursing 28 (4) pp. 401–408.

6. Homeier BP (2005). Bonding with your baby available online at www.kidshealth.org/parent/pregnancy_newborn/communicating/bonding.html (accessed on 4th January, 2008)

7. Kennel JH and Klaus MH (1998). Bonding: Recent Observations that Alter Perinatal Care. “Paediatrics in Review”: 19: 4 – 12

8. Kirsten G, Bergman N and Hann F (2001). The Management of Breastfeeding: Kangaroo Mother Care in the Nursery. “Paediatric Clinics of North America: 48 (2)

References9.  Linwood SA (2006) Bonding. “Children’s Encyclopaedia”. Available online at www.answers.com

(accessed on 10th January, 2008)

10. Miles M.S. (1989). Parents of chronically ill premature infants: Sources of stress. Critical Care Nursing Quarterly 12 (3) pp. 69–74

11. Minde K, Whitelaw A, Brown J, Fitzhardinge P (1983). Effects of Neonatal Complications in Premature Infants on Early Parent-infant Interactions. In: Kleberg A (2006). Promoting Preterm Infants’ Development and Mother Child Interaction, Karolinska Institute, Stockholm.

12. Mok E. and S.F. Leung (2006). Nurses as providers of support for mothers of premature infants, Journal of Clinical Nursing 15 (6) pp. 726–734.

13. Nkyekyer K, Enweronu-Laryea C, Boafo T (2003) Singleton preterm births in Korle Bu Teaching Hospital, Accra, Ghana – Origins and Outcomes. “Ghana Medical Journal” 2006 September: 40 (3): 93 – 98

14. Reproductive Research Unit, Obstetrics and Gynaecology Department, Biostatistics Unit – KATH, 2008

15. Salariya E (1990). Parent-infant attachment In: Alexander J, Levy V, Roch S (eds) Postnatal care – a research based approach, Macmillan, Basingstoke.

16. Shields L., I. Kristensson-Hallstrom and M. O'Callaghan (2003). An Examination of the Needs of Parents of Hospitalized Children: Comparing Parents’ and Staff's Perceptions. Scandinavian Journal of Caring Science 17 (2) pp. 176–184.

17. Weiss RE (2008). Ways to Bond with Baby. Available online at pregnancy.about.com/od/newbornbabies/a/waystobond.htm (accessed on 4 th January, 2008)