Mothers Of VLBW Infants Research Articles

Pressure to provide milk among mothers of very low birth weight infants: an explorative study

BackgroundPump-dependent mothers of very low birth weight (VLBW, < 1500g) infants experience specific challenges achieving sufficient milk supply in the neonatal intensive care unit (NICU) and are therefore less frequently able to achieve (exclusive) breast milk feeding. Stress due to the limitations on participating in the infant’s care may contribute to this problem. Some explorative studies suggest that pressure to provide milk may be an additional stressor in mothers. However, the type of pressure to provide milk perceived by mothers of VLBW infants has rarely been examined.MethodsA retrospective and anonymous questionnaire was conducted with mothers of VLBW infants aged 6 to 24 months at the time of data collection. Quantitative data and written comments were used to examine the mothers’ perceptions. Descriptive and bivariate tests (Spearman´s rho, Pearson’s chi2) were performed to show correlations between pressure to provide breast milk, parental stress (PSS:NICU: role alteration subscale), milk volume, and maternal factors. Pressure to provide milk was measured through two self-developed single items to differentiate between internal and external pressures.ResultsData of n = 533 mothers of VLBW infants was analysed. More than 70% of the mothers agreed that they pressured themselves to provide milk for their infant. In contrast, 34% of the mothers agreed that they felt pressure from outside to provide milk. Higher milk volume 14 days post-partum was significantly correlated with less internal (Spearman´s rho = 0.2017, p = 0.000) and less external pressure to provide milk (Spearman´s rho = 0.2991; p = 0.000). Higher PSS:NICU parental role alteration scores were significantly correlated with more internal (Spearman´s rho = -0.2865, p = 0.000) and more external pressure to provide milk (Spearman´s rho = -0.1478; p = 0.002). Milk volume 14 days post-partum and the PSS:NICU were not significantly correlated (Spearman´s rho = -0.0190; p = 0.701). Qualitative analyses highlighted these results and enhanced the bidirectional relationships between maternal pressure to provide milk and milk volume.ConclusionsEspecially internal pressure to provide milk is perceived by many mothers, being mutually dependent on milk supply and parental stress. Pressure to provide milk may be an important factor to decrease maternal stress in the NICU and, therefore, lead to more positive pumping and breastfeeding experiences. More research and validated instruments are needed to adequately measure pressure to provide milk with its different psychological, social, and environmental dimensions.

Transitioning Into the Role of Mother Following the Birth of a Very Low-Birth-Weight Infant: A Grounded Theory Pilot Study.

This qualitative grounded theory pilot study investigated the concerns and coping mechanisms of mothers of very low-birth-weight (VLBW; <1500 g) infants following discharge from the neonatal intensive care unit in Alberta, Canada. In-depth, semistructured, face-to-face, audio-recorded interviews were conducted with women of VLBW infants. Interviews lasting 75 to 90 minutes were transcribed verbatim and coded using grounded theory methodology. Data saturation and theoretical redundancy were achieved in interviews with 6 mothers of VLBW infants. The core variable of "reconstructing normal" emerged from the interview data. Women indicated that mothering a VLBW infant is an unfolding experience that is continuously being revised, creating a new sense of normal. The construct consists of 4 categories; mother-infant relationship, maternal development, maternal caregiving and role-reclaiming strategies, and infant developmental milestones. Findings from this study suggest that women found the transition into motherhood following the birth of a VLBW infant as a multidimensional and dynamic process. Further research is warranted to confirm these results and to further explore mothering issues with VLBW infants.

PTSS in fathers of VLBW infants two to four years postpartum: A pilot study.

Aim: The aim of the study was to conduct a pilot study to compare fathers of very low birth weight (VLBW; <1,500 g) infants and term infants at 2- 4 years postpartum for self-reported posttraumatic stress symptoms (PTSS) related to the previous birth of their baby and for depression and anxiety. The prevalence of paternal PTSS was compared with that of a historical cohort of mothers of VLBW infants followed up at a similar postnatal age. Method: Twenty-six fathers of VLBW infants and 22 fathers of term infants completed 4 validated psychological questionnaires at 2- 4 years postpartum. Results: PTSS levels were significantly higher in fathers of VLBW infants than in fathers of term infants, and PTSS levels did not differ significantly between fathers and the mothers of VLBW infants of a historical cohort. There was a significant association between perceived levels of social support and PTSS severity in fathers of VLBW infants but not for their anxiety or depression severity. Conclusion: PTSS directly related to the birth of their VLBW infants are present in fathers at 2- 4 years postpartum and occur at similar levels to those found in mothers of VLBW infants. Routine screening for PTSS in fathers of VLBW infants is important, and targeted psychological support should be offered. Larger-scale studies in the area are needed to elucidate further information about PTSS in fathers postpartum.

Strategies to Increase Milk Volume in Mothers of VLBW Infants

The provision of breast milk to premature VLBW infants is associated with significant health benefits. Unfortunately, the delivery of breast milk to these vulnerable infants is often limited due to insufficient maternal milk supply. Several interventions have been investigated with respect to increasing milk volume in mothers of VLBW infants but confusion exists concerning the interventions' effectiveness. The purpose of this systematic review is to critique the evidence regarding specific milk expression strategies that aim to improve milk volume in mothers of VLBW infants.Published article references, electronic databases, dissertations and theses, and select conference proceedings were searched with the goal of finding studies that target VLBW infants and milk expression techniques in which breast milk volume was an outcome. Analysis of evidence revealed an association between increased milk volume and early initiation of expression, increased frequency of expression, and provision of kangaroo care. The use of simultaneous or sequential milk expression and duration of milk expression sessions were not found to significantly improve milk volume. These results may be used to formulate specific strategies designed to increase breast milk volume in this population.

Delivering perinatal psychiatric services in the neonatal intensive care unit

To describe characteristics of mothers who would likely benefit from on-site short-term psychiatric services while their infant is in the neonatal intensive care unit (NICU). For 150 consecutive mothers who were referred for psychiatric evaluation and psychotherapeutic intervention in an innovative NICU mental health programme, baseline information was collected. Data regarding their referrals, diagnosis, treatments and infants were analysed. Most mothers were referred because of depression (43%), anxiety (44%) and/or difficulty coping with their infant's medical problems and hospitalization (60%). Mothers of VLBW infants were disproportionately more likely to be referred. A majority of mothers accepted the referral and were treated; most only required short-term psychotherapy. A minority resisted or refused psychiatric assessment; a quarter of these had more difficult interactions with staff or inappropriate behaviours. In these cases, the role of the psychiatrist was to work with staff to promote healthy interactions and to foster maternal-infant bonding. Overall, on-site psychiatric services have been accepted by a majority of referred NICU mothers, and most did not require long-term treatment. A considerable need exists for psychiatric services in the NICU to promote optimal parenting and interactions.

Correlates of lactation in mothers of very low birth weight infants.

We sought to determine the correlates of intent to breastfeed and of successful lactation and nursing at the breast in mothers of very low birth weight (VLBW; <1.5 kg) infants. We conducted a prospective observational study of 119 mothers of singleton VLBW infants (mean birth weight: 1056 g; mean gestational age: 28 weeks), 87 (73%) of whom intended to breastfeed. Mothers completed questionnaires at 3 weeks' postnatal age and at 35 and 40 weeks' (term) and 4 months' corrected ages (CAs). Of the 87 mothers who intended to breastfeed, 30 mothers (34%) continued lactation beyond 40 weeks' CA (postmenstrual plus postnatal age). Compared with mothers who discontinued lactation before this time, those who continued were older (31 vs 26 years), more were married (80% vs 39%), they had more than a high school education (70% vs 42%), and they were white (63% vs 35%). There were no significant differences in their infants' birth data or rates of neonatal morbidity. Significant correlates of lactation beyond 40 weeks' CA included beginning milk expression before 6 hours postdelivery, expressing milk > or =5 times per day, and kangaroo care. These correlates remained significant after controlling for maternal age, race, marital status, and education beyond high school. At 4 months' CA, 14 mothers (16%) were still lactating, 12 of whom were nursing at the breast. Increased maternal support specifically directed toward behavioral factors, including early and more frequent milk expression and kangaroo care, may improve the rates of successful lactation among mothers of VLBW infants who choose to breastfeed.

Caregiving to Very Low Birthweight Infants: A Model of Stress and Immune Response

Mothers of preterm, very low birthweight (≤1500 g; VLBW) infants experience the stress of caring for small, fragile infants at the same time that they are recovering from the relative immunosuppression of pregnancy and when many health behavior changes (e.g., nutrition) occur which also may influence immune status. The purpose of this study was to examine changes in anxiety and depression and in health behaviors, as well as lymphocyte proliferation and natural killer cell activity in mothers of preterm, VLBW infants compared to mothers of healthy term infants. Mothers of preterm VLBW infants have decreasedin vitrolymphocyte response to mitogens compared to mothers of healthy term infants over time, and this difference could not be explained by anxiety, depression, or health behaviors. However, among mothers of VLBW infants, anxiety was related to decreased lymphocyte proliferation response at 1 month postpartum. There was no relationship between maternal depression and lymphocyte proliferative response in mothers of term infants. Natural killer cell activity did not differ between the two groups of mothers, nor was there a relationship between natural killer cell activity and maternal anxiety, depression, or health behaviors. Thus, lymphocyte proliferative response to mitogens may be an important biologic marker of increased stress in mothers of VLBW infants in the first couple of months postpartum.

Anxiety and Depression in Mothers of Low Birthweight and Very Low Birthweight Infants: Birth Through 5 Months

The purpose of this study was to compare two common psychologic stress responses, anxiety and depression, in 27 mothers of very low birthweight (VLBW; less than or equal to 1500 grams) preterm infants and 35 mothers of low birthweight (LBW; 1501-2500 grams) preterm infants from the time of the infant's birth until the infants reached 5 months adjusted gestational age. There were significant differences in the patterns of anxiety and depression experienced by mothers of LBW and VLBW infants over time. Mothers of VLBW infants had higher anxiety and depression until 2 months adjusted gestational age while mothers of LBW infants had higher anxiety and depression at 3 and 4 months. Nursing interventions designed to decrease stress during the first postpartal week and to counsel mothers about patterns of anxiety and depression they may experience over time may be useful.