Mother-Infant Bonding

Mothering Care

Parents Care

Caregivers roles in the N.I.C.U.

Mother-Infant Bonding

By Dr. Maher Rashed, Ph.D.

Mothering Care

1- Mothers should have continuing support and reassurance during her pregnancy and delivery.

2- Social support is an important variable affecting mother - infant bonding. Mothers of little social support seemed to benefit more' from the early contact with their babies.

3- It is important to get great attention to early maternal perception about her baby.  "This may affect her feelings and behavior towards him; and that the manner in which a mother interacts with her baby will in turn; affects the baby's behavior towards her.

4- If at all possible, mother and infant should be kept near each other in the same' hospital, ideally on the same floor.

5- It is useful and safe for the mother to have the baby placed beside her in the bed in the first hour of life. This has to be done if the infant is doing well even if premature.

6- We should allow much more mother - infant interaction during periods of early hospitalization.

7- We must work to abolish hospital routines that separate mothers from their infants. This is to encourage the establishment of early positive mother- infant relationship.

8- The immediate postnatal period is a sensitive period of affectional bond formation.  So, Neonatal Intensive Care Units require a very thorough reevaluation permitting early mother - infant contact with skin to skin contact and eye to eye contact in the firs hour of life.

9- If at all possible, the mother should .share in care and nursing for her own infant in the N. I.C.U.

10- Rooming-in is still preferred-if possible.

11-    It is necessary to find out what the mother believes to happen or what she has read about the problems of her infant.

12- At least once a day, we should discuss with the parents how the infant is doing.  We may talk with them at least twice a day if the baby is critically ill.

13- An early intervention program for parents of high risk neonates via education and discussion groups. This is of great help to deal directly with their concern and misperceptions as early as possible.

14- It should be described to the infant's family that a synchronized relationship during the infant's first weeks of life has to be formed.

15- Parents - Physicians' interventions are often required to minimize pain and suffering of the anxiety feelings of parents at the time of low birth weight infant income.

16- We must reassure parents of premature babies about their future. Intellectual, physical or emotional development.

17- Every effort should be made to encourage facilitate parents visiting their infants. mother must be at ease handling the baby.

18- The physicians, nurses and social workers have to be sure that the mother is physically and mentally prepared before making the final plans for discharge.

19- It is recommended to record all visits and phone calls made by the parents to the intensive care nursery.  The records should be inspected at least weekly and investigate the cause of infrequent visiting.

20- Disorders of parenting as early as to control and prevent child abuse, non organic failure to thrive and abandonment.

From MSc Thesis (Maher Rashed et al., 1991)

Parents Care

1- Early skin to skin and eye to eye contact with the infant is very important for both mother and her baby.

2- Full details about neonatal intensive care unit and equipment should be given to the parents before incubation.

3- Parental visits and phone calls should be encouraged to facilitate bond formation. These are helpful in prevention of subsequent possible mothering disorders.

4- Encouraging extended visiting for the mother who can share nursing and dare - taking of her infant.

5- The eye patches of an infant who is under phototherapy should be removed when his mother comes to see him. This promotes eye contact.

6- Mothering disorders should be explored and managed when expected. This can be expected in

a) Previous loss of new born infant.

b) Fertility problem with no living children.

c) Previous severe ill newborn infant.

d) Primiparity younger than 17 or older than 38 years.

e) Any medical problem which may affect the infant.

7- The continuation of support to the mother is important during the hospital period with subsequent support at home by phone and repeated visits. This is of great help that the mother would visit, touch and provide increasing care for her baby.

From MSc Thesis (Maher Rashed et al., 1991)

Caregivers roles in the N.I.C.U.

1- Feeding should be based on cues i.e.  when the infant begins to become active and once a cycle of sleep-wakefulness can be recognized.

2- Gentle handling and avoidance of sudden postural changes are important.   These help providing variable sensory experiences and social interaction for the infant (Handling must be done after feeding time.  During feeding time, this may exhaust the infant).

3- Offering visual and auditory feedback must be geared to the infant's own initiation. This is when he read his an alert state and is ready to process such input.

4- Recognizing signs of stress and overload which may result in physiological deterioration.  These are represented by (a) facial grimaces, (b) increased jerky and startled movements, (c) labile colour changes (d) decreased muscle tone, (e) paling (f) instability of respiration and heart rate, (g) hiccupping, (h) spitting.

5- Responding appropriately to signs of stress help the infant to reorganize.  This is such as helping him to disengage from a visual stimulus.

6- Teach parents to recognize infant cues. This is to respond to him appropriately.

7- The neonate infant prefers faces, responds imitatively to adult gesture and to human sound. This social interaction should be recognized in adult-neonate's interpretation.

8- Supplemental stimulation in N.I.C.U.  is not an all or non phenomenon. Rather more adaptive individualized interventions that emphasize stress reduction and self regulatory skills are necessary. The approach will create for the premature infant a more optimal environment for growth and development.

9- The caregivers should not relieve their anxiety by adding their worries to those of the parents.

10- An infant should be sent home as early as possible to be better able to cope with the world in which he lives.

From MSc Thesis (Maher Rashed et al., 1991)