Abstract
BackgroundPreterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. This study sought to understand barriers and facilitators to provision of KMC in the NICU.MethodsWe conducted semi-structured in-depth interviews with mothers of preterm infants (N = 20) at a large academic medical center in Massachusetts. A series of open-ended interview questions were designed to elicit all aspects of mothers’ experiences and to understand how these experiences influence provision of KMC. All interviews were recorded and transcribed verbatim. We conducted an inductive thematic analysis to identify themes in the data with a focus on the barriers and facilitators of KMC provision in the NICU.ResultsFindings show that engaging in KMC is heavily influenced by the mental, emotional, and physical effects of preterm birth on the birth mother, such as stress around preterm birth and difficulty recovering from birth. These challenges are compounded by structural barriers such as costly accommodations, unreliable transportation, lack of child care, and inadequate maternity leave policies that limit the frequency and duration of KMC and parental ability to provide care.ConclusionsA complex array of mental, emotional, physical, and structural factors determine a mother’s ability to visit the NICU and provide kangaroo mother care. Providing social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation services, may address the structural barriers that inhibit KMC, reduce burdensome costs, and improve the health of mothers and their preterm infants.
Highlights
Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU)
We focused on mothers rather than partners or other family members as mothers were most likely to be present in the NICU and were the primary participant in certain aspects of kangaroo mother care (KMC), such as breastfeeding; mothers will be an important focus of future interventions planned by the research team to enable caregiving, including KMC, in the NICU and are the primary population of interest
Our findings indicate that ability to visit the NICU—which is required to engage in KMC—among financially-strained families is heavily influenced by these structural barriers and their associated costs, burdening all participating mothers regardless of hospital financial support or insurance status
Summary
Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. In 2016, approximately one out of every 10 infants born in the United States was born premature [2] Preterm infants, those born before 37 weeks of gestation, have higher risk of morbidity and developmental delays, as well as breathing problems, feeding difficulties, vision problems, and hearing impairment [3, 4]. Studies have shown associations between poorer socioeconomic condition and increased risk for preterm birth, as well as increased rates of preterm birth among black women even after accounting for socioeconomic factors [12, 13]
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