Barriers That Exist For New Mothers With Preterm Babies
Having a new baby is supposed to be an experience that brings joy and happiness. The birth of a baby is a beautiful gift that many women get to experience successfully in their lives. Unfortunately, despite the medical advancements that have been made, childbirth is still one of the most dangerous events for a women and baby to experience. There is a myriad of things that can go wrong and many babies are born before they have reached full-term. A baby is full-term when they are born between 37 and 42 weeks. The birth of a preterm baby can be very difficult for a new mother. There are multiple barriers that exist for new mothers while they are in the hospital as well as when they leave the hospital. This article will focus on these barriers.
In the United States alone, approximately 450,000 babies are born prematurely. More than 80% of these preterm births are unanticipated and lead to many barriers to care, both in and out of the hospital (Dolezel, 2019). One of the biggest barriers to the care of a newborn for mothers is the development of postpartum depression (PPD) and anxiety. After a full-term delivery, between 10 to 15% of women develop PPD; whereas almost half of the women who have a premature birth will suffer from PDD.
There are several reasons why women with premature infants have a higher likelihood of developing PPD (Ihonge & Masho, 2017). One of the most common reasons women with a premature infant develop PPD is increased stress. In addition, women may struggle with feelings of helplessness, exclusion, and lack of sufficient knowledge on how to care for their babies and interact with them. Other common causes of PPD include being a single mother, having other coinciding, stressful life events, partner violence, partaking in risky behavior before pregnancy, never having breastfed or previous difficulties breastfeeding a child, unintended pregnancy, and having a partner/spouse that is deployed in the military at the time of birth. The best way to prevent the development of PPD and to treat it is to perform routine screening for PPD using standardized tools during hospitalization, at discharge, and six weeks following delivery. When women are identified as having risk factors for depression, they should be monitored closely for the signs of symptoms of PPD so that it can be identified early and appropriately treated, especially in the case of mothers of preterm infants (Ihonge & Masho, 2017).
There are many other barriers that exist for women with preterm babies. These include lack of insurance and access to medical care, low incomes, lack of social support, as well as the high cost of care for new mothers and their preterm babies (World Health Organization, 2012). The lack of health insurance, low income and high cost of care can decrease a women’s access to quality medical care, making it more difficult for her to receive the appropriate preventative prenatal care and for the premature baby to receive the necessary medical care he or she requires after birth. Lack of social support makes it difficult for the mother to attend her and her baby’s appointments and can make it difficult for her to cope with the stress and complete the basic required care.
Despite these and other barriers that exist for mothers of preterm babies, there are interventions that can be utilized to ease the burden and help educate mothers and their families. One of the most important things that preterm infants need is nutrition and warmth. Involving the mother in the feeding of her infant as well as having her participate in kangaroo care can greatly help her baby get the nutrients that he or she needs as well as help regulate their temperature, which is a frequent issue for preterm babies. In addition, kangaroo care can also help facilitate mother-baby bonding (Cleveland Clinic, 2019). Healthcare professionals are involved in every aspect of a preterm baby’s life and care and it is important that the mother form good relationships with these providers. These strong relationships can foster feelings of trust and support that will hopefully continue long after hospital discharge.
Additionally, caring for a preterm infant can be quite costly and require a lot of extra time and care if the infant develops cognitive or motor disabilities, both of which can occur with increased frequency when a baby is born weeks before their due date. Medicaid has a children’s program called the Children’s Health Insurance Program (CHIP), which offers assistance that families can apply for when they have children (Centers for Medicare & Medicaid Services, 2019). There is also the Temporary Assistance for Needy Families (TANF) program which helps pay for children’s medical cost (Office of Family Assistance, 2019). If a preterm infant develops a disability, there is the Individuals with Disabilities Education Act (IDEA) that helps children with long-term health conditions receive a variety of services (Department of Education, 2019). There are multiple services available for mothers and families with preterm infants; they just may need help identifying and applying for the appropriate assistance programs.
In regard to health-care providers, there are many topics and discussions that they can have with a mother and her family to help them provide the best care for their preterm infant and avoid some of these barriers. During their stay in the hospital and after discharge, mothers should receive basic information about premature infants and the medical care they require as well as education on interacting with and feeding their baby. The general medical guidelines state that a preterm baby can go home when they weigh at least four pounds, can keep warm without the use of an incubator, can breast feed/bottle feed, gain weight steadily (1/2 to 1 ounce a day), and can breathe on their own (Bird, 2019). Mothers should be educated on these guidelines so that they can better care for their babies, be informed about their medical care, and have reasonable expectations on when they will be ready to leave the hospital.
Medical care can often be complex and difficult to comprehend. Therefore healthcare providers can perform educational activities to help ensure that mothers understand the information they are being taught. These activities combine information with practical interventions that mothers perform with their premature infants. These activities differ amongst teams but should always include the mother and other family members involved in care. Education should start during the hospitalization so that mothers are not having to learn and absorb large quantities of information at discharge. Starting early in the hospitalization can help them better absorb the information being presented over time instead of all at once. Using the teach-back strategy has been proven to be effective in helping patients retain information given to them. To use this strategy, the mother states back in her own words what the healthcare provider told them, helping the provider determine how well the information was understood. As a lot of medical terminology can be hard to understand and remember, adapting the terminology and considering cultural factors can greatly increase the amount of information a mother retains. Educational booklets are often available for mothers to take home and refer to later and there are multiple educational websites that mothers can refer to at home. Overall, there are several barriers that a mother of a premature infant may face; however, with the appropriate strategy and preparation these barriers can be mitigated and potentially avoided.
References
Bird, C. (2019, July 22). When can premature babies go home? Retrieved from https://www.verywellfamily.com/milestones-a-nicu-baby-must-reach-before-discharge-2748598
Centers for Medicare & Medicaid Services. (2019). Children’s health insurance program (CHIP). Retrieved from https://www.medicaid.gov/chip/index.html
Cleveland Clinic. (2019). Kangaroo care. Retrieved from https://my.clevelandclinic.org/health/treatments/12578-kangaroo-care
Department of Education. (2019). Individuals with disabilities act (IDEA). Retrieved from https://sites.ed.gov/idea/about-idea/
(Dolezel, J. (2019, August). Premature birth facts and statistics. Retrieved from https://www.verywellfamily.com/premature-birth-facts-and-statistics-2748469
Ihongbe, T, O., and Masho, S, W. (2017). Do successive preterm births increase the risk of postpartum depressive symptoms? Journal of Pregnancy, 2017, 1-10. doi: 10.1155/2017/4148136
Office of Family Assistance. (2019, October 3). Temporary assistance for needy families (TANF). Retrieved from https://www.acf.hhs.gov/ofa/programs/tanf
World Health Organization. (2012). Born too soon: The global action report of preterm birth. Retrieved from https://www.marchofdimes.org/materials/born-too-soon-the-global-action-report-on-preterm-birth.pdf