Mothers’ perception of Newborn Individualized Developmental Care and Assessment Program (NIDCAP) as compared to conventional care
Introduction
During the course of a normal pregnancy, the pregnant woman continuously becomes more psychologically prepared to become a mother and to attach to her newborn infant. The healthy, full-term infant is capable of interacting with its environment and to make eye contact. The awake infant can cope with different impressions simultaneously, and is able to attain an alert state of wakefulness, including listening to and turning towards its parents [1]. The full-term infants’ evident communication guides the parents into new interactions.
In contrast, the prematurely born infant is not sufficiently mature to interact and deal with external stimuli, and as a result the infant is hypersensitive and may overreact with e.g. increased or decreased motor action, irregular breathing or apnoea [2], [3], [4]. A probable explanation for this is that the cerebral cortex and the rich subcortical networks are not fully matured. Organization of the neurons in the frontal lobe, the site of intelligence and personality, occurs at a late stage of gestation. Consequently, in order not to disturb the development of the premature infant during this highly sensitive phase, interactions must be adjusted to the child’s degree of maturation [5].
For the preterm infant, the neonatal intensive care period often involves painful stimuli and discomfort, and the preterm infant’s energy may become devoted to reacting to these and other environmental stimuli, resulting in less energy for parental interaction. The parents may be anxious about their infant’s survival and possibility of surviving without handicap.
Furthermore, the neonatal staff with experience of preterm infants may convey an impression to the parents that they know and understand the infant better than the parents. Under such circumstances the parents must begin to get acquainted with, and bond to their child. Several investigations have revealed that mothers experience premature birth, and the neonatal intensive care environment as very traumatic and stressful, and they often express feelings of anxiety, fear, guilt, anger and helplessness [6], [7], [8]. Such feelings may influence the process of bonding negatively, and may be further enhanced by the premature infant’s weaker signals and lower alertness and responsiveness [9], [10], [11], [12], sometimes to such a degree that the mother feels that her infant avoids contact.
The Newborn Individualized Developmental Care and Assessment Program, NIDCAP, was designed to create a relationship-based developmentally supported care environment for the premature infant and its family [13], [14]. The NIDCAP is based on structured observations of the infants’ behaviour and response during a care procedure. The timing and nature of care is subsequently adapted to suit the infants’ present state and behaviour. The parents are encouraged to learn how to interpret their infant’s signs and to participate in the care as early as possible. Moreover, the infant is considered to be an active communicator and participant in its own development [15], [16].
The aim of the present study was to investigate whether care according to NIDCAP, as compared to conventional care, affects how mothers of preterm infants experience their feelings of closeness to their infant, their role as a mother, and how they perceive the neonatal staff and the neonatal care. Several validated questionnaires evaluating parental stress in the NICU are available for term and preterm infants [17], [18], [19], [20]. The reason for constructing the current questionnaire was that we, in the perspective of the randomized NIDCAP-intervention, wanted to evaluate not only negative stress factors but also positive factors related to early bonding between mother and infant.
Section snippets
Patients and methods
The study group consisted of 20 mothers of preterm infants who were enrolled in a randomized controlled trial evaluating the medical effects of care based on NIDCAP, versus standard neonatal care, at the level III Neonatal Intensive Care Unit (NICU) Karolinska Hospital, Stockholm, Sweden. The infants were inborn, singleton infants with gestational age below 32 weeks, who needed ventilatory support with continuous positive airway pressure (CPAP) or mechanical ventilation during the first 24 h of
Differences between the NIDCAP and the conventional care groups
The mothers in the NIDCAP group gave “the feeling of closeness between her and her infant” a significantly higher score than mothers of infants treated with conventional care, median (range) 4 (3–4) versus 3.5 (2–4), p = 0.022. Of the 5 statements included in this subscale, there was a significant difference in the mothers’ attitudes towards the importance of eye contact, 4 (3–4) for the NIDCAP group versus 3 (2–4) for the conventional care group, p = 0.05 (see Table 6). In order to investigate
Discussion
The major finding of the present investigation was that mothers of prematurely born infants receiving care according to NIDCAP felt closer to their infants, but also experienced a higher level of anxiety than the mothers whose children received conventional neonatal care.
Closer examination of the subscale “feeling of closeness to her infant” revealed that the mothers in the NIDCAP group more frequently said that they had eye contact with their infants, which is well known to be an important
Conclusions
The mothers of premature infants receiving care according to NIDCAP felt closer to their infants, perceived more eye contact, experienced more anxiety, who might be interpreted as a sign of early bonding, and tended to experience more support from the staff in taking over the care of their infants than did the mothers given conventional care. This finding indicates that early NIDCAP intervention may facilitate participation of the mother in care-giving on a neonatal intensive unit, as well as
Acknowledgements
We thank Björn Westrup, Hugo Lagercrantz, Karin Stjernqvist and Kristina von Eichwald for their support in this study. Statistical analyses were performed by Jan Ifver. The study was financially supported by The Dalarna Research Institute, First of May Annual Flower Campaign, Södra Sveriges Sjuksköterskehem Foundation, Solstickan Foundation, Sven Jerring Foundation, Smedby Foundation, the Swedish Association of Paediatric Nurses, Lund University Funds, and the Federation of County Councils and
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