Mother-baby Unit Research Articles

Perinatal and postnatal treatment of traumatized parents with mental disorders: impact on parents and their children

In traumatized parents with mental disorders, pregnancy and related medical examinations can lead to high emotional distress and flashbacks and increase the already tense emotional situation. Besides psychiatric burdens, parental insecurity concerning dealing with and reduced sensitivity for the child often exist. The children themselves have a higher risk of being neglected or abused and to also develop mental disorders. How does interventional research take the special needs of traumatized parents with mental disorders into account? What kind of interventions predominate and what impact do they have on parents and children? Publications on perinatal and postnatal interventions for traumatized and mentally disordered parents were included in the review if at least one intervention was explicitly described, aparental trauma was discussed and the impact of the intervention on the parents and children was analyzed. A total of 2reviews and 10interventional studies were included. Interventions were primarily based on professional educational counseling, psychoeducation, nurse home visits, individual and group therapies and inpatient mother-baby units. The interventions led to reduced psychiatric symptoms, enhanced parental sensitivity for the child's needs, enhanced quality of nurturing and care and an improved mother-child bonding. Although only few studies focused on the special needs of traumatized, mentally disordered parents, the described interventions show promising effect sizes, especially in combination with several kinds of interventions. Nevertheless, an adequate integration of fathers into the therapies has so far been neglected.

An Institutional Approach to the Management of Asymptomatic Chorioamnionitis-Exposed Infants Born ≥35 Weeks Gestation.

We compared 123 chorioamnionitis-exposed infants born 1 year before implementation (pre-algorithm group, April 1, 2016, to March 31, 2017) with 111 born 1 year following implementation (post-algorithm group, April 1, 2017, to March 31, 2018). The primary outcome measure was analyzed monthly using a run chart. The maternal and neonatal characteristics were similar between both groups. Significantly fewer infants in the post-algorithm group received antibiotics compared with the pre-algorithm group (4.5% versus 96.8%; P < 0.01). There were no differences in median hospital length of stay or incidence of neonatal intensive care unit admissions between both groups. There were no positive blood cultures or readmissions within 7 days for early-onset sepsis in either group. An institutional approach of monitoring chorioamnionitis-exposed infants with a clinical and laboratory evaluation decreased antibiotic utilization in the mother-baby unit by 95% without an increase in hospital length of stay, neonatal intensive care unit admissions, or readmissions for early-onset sepsis.

A Parent-Targeted and Mediated Video Intervention to Improve Uptake of Pain Treatment for Infants During Newborn Screening: A Pilot Randomized Controlled Trial.

Most newborns undergo newborn screening blood tests. Breastfeeding, skin-to-skin care, and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. We conducted a 2-armed pilot randomized controlled trial in a mother-baby unit to examine the feasibility and acceptability of a parent-targeted and -mediated video demonstrating use of these pain-reducing strategies and to obtain preliminary effectiveness data on uptake of pain management. One hundred parent-newborn dyads were randomized to view the video or receive usual care (51 intervention and 49 control arm). Consent and attrition rates were 70% and 1%, respectively. All participants in the intervention arm received the intervention as planned and reported an intention to recommend the video and to use at least 1 pain treatment with breastfeeding or skin-to-skin care preferred over sucrose. In the intervention arm, 60% of newborns received at least 1 pain treatment compared with 67% in the control arm (absolute difference, -7%; 95% confidence interval, -26 to 12). The video was well accepted and feasible to show to parents. As there was no evidence of effect on the use of pain management, major modifications are required before launching a full-scale trial. Effective means to translate evidence-based pain knowledge is warranted.

MOTHERS AND THEIR INFANTS CO‐ADMITTED TO A NEWLY DEVELOPED MOTHER–BABY UNIT: CHARACTERISTICS AND OUTCOMES

Research on Mother-Baby Units (MBUs) has mainly focused on maternal psychiatric outcomes, not the well-being of infants. This study investigated infant development and mental health along with maternal characteristics and the mother-infant relationship in 45 dyads (60% New Zealand European, 20% Māori, 11% Pacific) admitted to a new MBU. Maternal psychopathology was measured with the Health of the Nations Outcome Scale (HoNOS, J.K Wing etal., 1998) and Global Assessment of Functioning (GAF; I.M. Aas, 2010). The Parent-Infant Relationship Global Assessment Scale (PIR-GAS, Zero to Three, 2005) measured the mother-infant relationship. Infant measures included Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Zero to Three Press, 2005) and the Ages & Stages-3 (J. Squires, E. Twombly, D. Bricker, & L. Potter, 2009). Maternal mental illness and functioning improved during the admission and were positively associated with longer inpatient duration and no illicit substance use. Well-being of the infants was concerning. In addition to lower birth weights and poorer health status, at discharge 51% were lagging behind developmentally, and 51% were exhibiting signs of infant mental health concerns. Relationally, 67% of mother-infant dyads had features of, and 29% met criteria for, a disordered relationship. Poorer mother-infant relationships were associated with a maternal diagnosis of schizophrenia or bipolar disorder, use of the Mental Health Act, leaving the MBU early, limited social support, and infant mental health diagnosis.

Impact of a prenatal episode and diagnosis in women with serious mental illnesses on neonatal complications (prematurity, low birth weight, and hospitalization in neonatal intensive care units).

Pregnancy in women with mental disorders is increasingly common. The aim of this study was to determine, in women with severe mental illnesses, whether a prenatal episode was related to neonatal complications and if a specific disorder was associated with a higher risk. A population of infants and their mothers (n = 1439) jointly admitted to psychiatric Mother-Baby Units in France and Belgium (2001-2010) was assessed respectively for prematurity, low birth weight (LBW), hospitalization in neonatal intensive care units (NICUs), and maternal mental health during pregnancy. Logistic regression was used to explore the association between neonatal complications and a prenatal episode of mental illness and if the presence of a specific disorder was related to a higher risk, taking into account maternal socio-demographic characteristics, pregnancy data, and antenatal exposure to psychotropic drugs. Among the children, 145 (10.2%) were premature, 226 (15.8%) had a LBW, and 348 (24.3%) have been hospitalized in neonatology. The presence of an episode of mental illness during pregnancy was linked to LBW (OR = 2.21 [1.44-3.38]; p = 0.003) and NICU hospitalizations (OR = 1.53 [1.06-2.19], p = 0.002). Among diagnoses, the presence of a severe substance use disorder in these women was related to LBW (OR = 2.96 [1.49-5.85]; p = 0.002) and NICU (OR = 2.88 [1.56-5.29]; p = 0.04). Our results underline the importance of systematic and early detection of psychiatric symptoms and substance use disorders during pregnancy in preventing neonatal complications in women with serious mental illness.

Barriers and facilitators to using pain treatment during newborn screening blood tests at a mother-baby unit

BackgroundNewborns undergo blood tests for newborn screening (NBS). Breastfeeding, skin-to-skin care (SSC) and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. AimsTo assess the utilization of, and barriers and facilitators to using pain treatment during NBS. MethodsOnline survey of nurses in a mother-baby unit ascertaining pain management during NBS, and barriers/facilitators to using the three strategies. Participants viewed a video portraying the use of each strategy during NBS. ResultsThirty-six of 45 nurses participated (response rate = 80%). Thirty-five (97%) reported completing NBS outside the patient's room. Breastfeeding was sometimes supported (44%) and 40% never suggested SSC, while 53% often used sucrose. After viewing the video, nurses preferred sucrose (mean = 82) over breastfeeding (mean = 44) or SSC (mean = 44). Main barriers to using breastfeeding and SSC were ergonomics, contextual factors and time. ConclusionsFurther work is warranted to address barriers to using evidence-based pain treatment for newborns during NBS.

Specialized Care of Women and Newborns Affected by Opioids With a CORE Team of Nurses

Staff on a mother–baby unit of a large suburban Level II facility identified the need to provide specialized nursing care to women affected by opioids. The manager of the unit recognized inconsistencies in care and frustration expressed by women and staff. She recruited a CORE (Champion for our Opiate patients using Respectful and Relevant Engagement and Education) group of staff nurses to care for these women. CORE nurses received specialized education and resources and served as the primary nurses for women admitted to the unit with a positive urine drug screening result or a history of drug use during pregnancy. Having a CORE team has brought a consistent approach when providing care to families affected by opioids.

Format of Parent Education Material Preferred by New Mothers

A descriptive cohort study to determine new mothers' preferred modality for educational materials, and if the format impacted the mothers' perception of an evidenced-based practice safe sleep program. The sample included new mothers anticipating discharge from a mother-baby unit with their newborn. Participants responded to a four-item survey administered by a research assistant. Respondents' self-reported preferred format for patient education was technology-based materials in both cohorts. The video teaching material as compared with the paper handout was rated significantly higher by participants. Modalities of patient education in health care organizations need to be consistent with the changing ways people are learning and accessing information in their everyday life.

'Singing with your baby': an evaluation of group singing sessions for women admitted to a specialist mother-baby unit.

This paper reports on the acceptability, experience of participation and the immediate impact on maternal mood state of group singing sessions, introduced as a routine component of a mother-baby unit (MBU) treatment programme. Data was collected from 27 women who participated in the pilot programme. Results showed that implementation of a singing intervention in this setting is positively appraised by women and is associated with positive changes in self-reported mood state from pre- to post-session. Key facilitators and barriers to the success of the programme and directions for future research are discussed.

Patient experience of a psychiatric Mother Baby Unit.

BackgroundMothers with severe mental illness are vulnerable and engage with services cautiously due to fears of stigma and custody loss. To develop best practice standards and patient-centred services, the subjective experience of those who use it must inform service improvement and policy.MethodThis study utilised exploratory concurrent mixed methods design with primarily qualitative data. Women admitted between April 2015 and December 2016 to a newly developed psychiatric Mother Baby Unit (MBU) in New Zealand were invited to participate in this study. Qualitative data were collected in three ways: (i) semi-structured interviews incorporating Māori concepts of health and wellness by research assistants near discharge; (ii) invitation to provide anonymous feedback in writing using an open format; (iii) unsolicited verbal feedback provided during a home visit three months after discharge. Thematic analysis was undertaken. Demographic and clinical information was collected prospectively for mother-infant pairs during the course of admission and three months post-discharge.ResultsForty-five people participated in the study. High rates of satisfaction were described. Strengths of the service–as perceived by mothers–included co-admission of mother and infant, staff warmth and availability, transparent practice, inclusion of families, and having a comfortable environment. Mothers described intense distress and confusion, as well as negative self-perceptions when acutely unwell. Infant co-admission and the inclusion of partners and other family members alleviated mothers’ distress. Personal attributes of staff, practical support with caregiving, a range of therapeutic approaches and holistic care were all valued. Feedback collected three months after discharge was the most reflective. Significant inter-ethnic differences were not apparent.ConclusionsThe experience of inpatient care can have lasting influence on recovery and wellbeing. Employing a Māori model of health broadened the holistic nature of enquiry. The approach and timing taken in seeking the views of participants’ yielded different information, all of which is of value to service evaluation and refinement. The findings suggest that keeping mothers and infants together during health service utilisation such as MBUs should be a priority for policy makers and service designers. This approach is consistent with Māori values, combining the importance of whānau relationships (kinship), wairua (spiritual connectivity), hinengaro (the mind) and tinana (physical health). These findings suggest that ‘holistic care’–in this case following a Māori holistic health model–is important in mental health settings.

Perspectives of Nurses, Nurse Leaders, and Women Regarding Anticipatory Rounds in the Postpartum Period

ObjectiveTo obtain the perspectives of staff nurses, nurse leaders, and women with regard to the relevance and timing of nursing interactions during anticipatory rounds in the postpartum period. DesignA qualitative descriptive design using focus groups. SettingA hospital with 405 beds that serves a Midwestern U.S. community of approximately 256,000 people. ParticipantsA purposive sample of 12 staff nurses, 6 nurse leaders, and 15 women attended a total of 10 focus groups. MethodsWe conducted 10 semistructured focus groups: 6 with staff nurses, 1 with nurse leaders, and 3 with women. Each participant attended one focus group. Sessions were recorded and transcribed. Investigators independently coded transcripts and identified themes collectively. ResultsParticipants identified one overarching theme, Taking the Whole Picture Into Account, and five subthemes that were reflective of relevant nursing interactions: Help With Newborn Feeding, Managing Patient Comfort, Appreciating the Need for Safety, Being There, and Knowing Ahead of Time. Participants agreed that conducting rounds once every 2 to 3 hours was the most appropriate time frame. ConclusionParticipants identified important nursing interactions and their timing. Moreover, anticipatory rounding for women after birth includes more than completion of simple tasks or checklists. These findings indicate beginning evidence for what should occur during anticipatory rounds on the mother–baby unit. Timing of rounds can be flexible based on each woman’s unique needs, thus reinforcing patient-centered care. However, interactions and timing should take place only when the whole picture is taken into account.

Pregnancy in women with psychotic disorders: risk factors associated with mother-baby separation.

Pregnancy in women suffering from psychotic disorders is becoming more common. However, this psychiatric disorder is linked to the highest risk of early mother and child separation. The aim of this study was to evaluate risk factors associated with these separations. In an observational, naturalist, and multicentric study, 320 women suffering from a psychotic disorder and jointly hospitalized with their child in one of the sixteen mother-baby units (MBUs) in France and Belgium between 2001 and 2010 were assessed for risk factors associated with mother-child separation. Eighty-seven (27.2%) mothers were separated from their infant at discharge from MBUs. Early separation was linked to the placement of the mother herself in an institution in childhood (OR 4.44; CI 95% 1.12-18.69), to the mother being single (OR 3.84; CI 95% 1.38-11.44), to early hospitalization of the baby in neonatology (OR 2.88; CI 95% 1.27-6.59), and to maternal psychiatric decompensation during pregnancy (OR 2.60; CI 95% 1.15-6.20), independently from maternal neglectful behaviors. Low family/social support showed a trend towards association with separation (OR 2.17; CI 95% 0.91-5.42). This study shows that separation is mostly linked to mothers' environmental and interactive past and current history, to the child's health, and to maternal mental health decompensation. The identification of these factors is essential to implement antenatal prevention and social programs for these women. Further studies should focus on the long-term development of children of schizophrenic mothers, whether or not they have been placed, in order to help clarifying the impact of the risk factors.

Coupling Breast Feeding and Smoking Cessation: A Quality Initiative

OBJECTIVES To improve referral rates to the New York State Smoker’s Quit line (NYSSQL) in post-partum women admitted to our Children's Hospital; to improve breastfeeding rates among post-partum mothers who smoke presently, or identified as smoking within the past year. METHODS From 8/9/2016 to 3/2/2017 nurses in the mother-baby unit provided a brief (5 – 15 minute) motivational interviewing session to new smoking or recently quit mothers …

Case 2: Vesicular Lesions of the Oral Mucosa

A term female infant (39+4 weeks) with a birthweight of 3,055 g is born via spontaneous delivery to a gravida 4, para 3 woman. Maternal history is significant for Ashkenazi Jewish heritage and known connective tissue disease requiring plaquenil. Maternal serologies and prenatal testing are unremarkable with the exception of herpes simplex virus (HSV) 1 immunoglobulin (Ig) G being positive and IgM inconclusive. The mother was not taking antiviral therapy during pregnancy or at delivery. On admission to the labor and delivery department, the infant’s mother is without prodromal symptoms or genital lesions concerning for HSV. The patient is born via spontaneous vaginal delivery through meconium-stained amniotic fluids, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. At the time of delivery, the infant has normal physical examination findings and is kept in the mother-baby unit for routine newborn care. At about 30 hours after birth, the newborn team is called to the bedside by the nurses because of the development of vesicular lesions on the oral mucosa of the lower lip (Fig). On examination of the oral mucosa, multiple vesicular lesions are noted, which measure 1 to 2 mm in size. Because of …

Factors That Influence Parents' Adherence to Safe Sleep Guidelines

ObjectiveTo explore factors that influence parental behaviors related to newborn sleep positions and environments in the home after hospital discharge. DesignA descriptive qualitative study conducted by telephone. SettingA 290-bed academic teaching hospital in an urban setting with a Level 3 perinatal center and approximately 4,500 births per year. ParticipantsParticipants (N = 60) were recruited from the patient population of the mother–baby unit. All participants were scheduled to be discharged simultaneously with their newborns. MethodsQualitative interviews with grand tour–style questions were conducted by telephone. An inductive analysis process was used to identify themes and meaning. ResultsParticipants described three consistent factors that influenced how the newborn slept at home. The most frequently mentioned influence was Other People followed by Nobody/No One and Images from sources such as books, pictures, television, and the Internet. ConclusionNew parents need education about the rationale for the safe sleep guidelines from the American Academy of Pediatrics (AAP) as well as knowledge of the potential harm of behaviors such as bed sharing and prone or side-lying positions for sleeping. The images to which parents are exposed send mixed messages. Health care professionals should portray safe sleep for infants in media, marketing materials, and other graphic representations. Nurses should help parents understand the AAP's recommendations for safe sleep position and environment for infants so that they can become advocates for their newborns' well-being.

Outcomes Associated With Type of Milk Supplementation Among Late Preterm Infants

ObjectiveTo assess whether type of milk supplementation provided to breastfeeding late preterm infants was associated with hospital length of stay (LOS) or breastfeeding status at discharge. DesignRetrospective chart review. SettingTertiary care teaching hospital in the southern United States. ParticipantsLate preterm infants 35 0/7 to 36 6/7 weeks gestational age (N = 183) admitted to the mother-baby unit between November 1, 2014, and October 31, 2016. MethodsThe exposure of interest was type of milk supplementation, for example, expressed human milk, pasteurized donor human milk, and formula. Outcomes measured were LOS and breastfeeding status at discharge. Generalized Poisson regression models were used to compare LOS by type of milk supplementation. Modified Poisson regression models were used to estimate risk ratios and 95% confidence intervals for associations with breastfeeding status at discharge. ResultsThe LOS for breastfed infants supplemented with expressed human milk and/or pasteurized donor human milk did not differ significantly from exclusively breastfed infants who received no supplement. Exclusively formula-fed infants had longer LOS of 3.2 days compared with 2.6 days for exclusively breastfed infants (p = .001). Breastfed infants who received any formula supplementation were 16% less likely to continue breastfeeding until day of discharge compared with breastfed infants who received human milk supplementation (risk ratio = .84, 95% confidence interval [.77, .92]). ConclusionThe high prevalence of supplementation among breastfeeding late preterm infants underscores the potential effect of type of milk supplementation on LOS and breastfeeding outcomes. Our findings suggest that human milk supplementation discourages transition to formula feeding before hospital discharge without increasing LOS.

The Nuts and Bolts of Implementing a Pasteurized Donor Human Milk Program on a Mother Baby Unit.

The Nuts and Bolts of Implementing a Pasteurized Donor Human Milk Program on a Mother Baby Unit.

The Relationship Between Maternal Fatigue and Observed Unsafe Infant Sleep Practices

To determine if a relationship exists between maternal fatigue and unsafe maternal–infant sleep practices or infant drops. Descriptive study design. Three randomly designated postpartum rooms in a 33-bed mother–baby unit that provides couplet nursing care. A convenience sample of 92 women in the postpartum period, 18 years and older, English speaking, and not receiving intravenous magnesium sulfate for hypertension. The time frame studied was time to admission to the mother–baby unit to discharge from the hospital. Women were assessed hourly for fatigue using the Stanford Sleepiness Scale. In addition, the hospital room environment was assessed hourly for evidence of unsafe sleep practices using an investigator developed environmental safety survey. Unsafe sleep practices that were identified were immediately rectified. During the project period, five infant drops occurred although no infant drops occurred among the 92 participants. Unsafe infant sleep practices were identified in 22% (n = 20) of the participants and immediately rectified. Common unsafe sleep practices included a hospital bed not in its lowest position, co-sleeping, and having less than two side rails in upright position. These mothers averaged 6.8 hours of observed sleep (0–13 hours) during the postpartum hospital stay (31–59 hours) with an average sleep interval of 2.94 hours (0–6 hours) Hourly observation of environment and subjective assessment of maternal fatigue may prevent infant drops.

Early Recognition of Neonatal Sepsis by Nurses

To understanding what behavioral and physiologic cues in neonates with evolving sepsis are salient to nurses and will allow for the development of a neonatal early warning system. Descriptive correlational. Tertiary academic medical center. Neonatal nurses (N = 181). Online survey to assess nurse’s knowledge of behavioral cues and physiological signs of sepsis. This study indicates that nurses can recognize the physiological and behavioral cues of sepsis in normal and at risk neonates. Although there were some similarities in characteristics, there were limited differences between nurses with ADN and BSN degrees. Nurses with more than 11 years of experience who practiced in the NICU were able to identify more frequently behavioral cues associated with newborn sepsis than those who practiced in the mother baby unit (t = 2.6, df = 1, p = .011). Neonatal sepsis is the leading cause of pediatric mortality worldwide, and 20% of related deaths are associated with late and improper treatment. Nurses have the ability recognize sepsis early using a combination of behavioral and physiologic cues observed in the neonate. Closing the knowledge gap related to years of experience and practice setting is crucial to early recognition of sepsis. Future researchers should examine whether these cues were present before sepsis diagnosis. This will allow for the implementation of a neonatal early warning system for sepsis. The use of a systematic surveillance tool will help to close the experience gap identified in this study.

Implementing Kangaroo Care in the Postpartum Period

Unsafe positioning of the healthy newborn during kangaroo care (KC; skin-to-skin contact) can lead to negative outcomes. However KC, which is commonly done immediately after birth, does have benefits when utilized correctly during the postpartum period. Before the program, KC in the postpartum period was not routine practice, and when it was used, safe positioning techniques were inconsistently followed and were not documented in the electronic medical record (EMR). To educate staff about KC on a mother–baby unit in a community hospital. A secondary goal was to increase documentation of KC. Strong stakeholder support and interdisciplinary teamwork were necessary to implement staff education and increase documentation of KC. Documentation was built into the EMR with support from the nursing informatics team and input from the entire health care system. Education on safe positioning, benefits, and the purpose behind documentation of KC was provided during the annual, mandatory competency period. Results of this project had statistical and clinical significance. Initially, no KC was documented, and now we average 118 minutes of KC per newborn. Implementing KC in the postpartum period can be accomplished but requires a planned process change and an understanding of potential barriers and facilitators within the organization.