Parental Guidance Encouraged

Family-centered care brings parents back into the fold.Maybe nine months of mental preparation just isn’t enough. Most of us do our best to smooth the path for baby’s birth and early days, hitting the stores for baby accoutrêments and keeping a close watch on mom’s health. But the little bundle of joy’s arrival can still hit like a ton of bricks. There’s the overarching joy and anticipation of happy days to come, for sure, but also uncertainty and nagging worries that stretch out ahead like so many sleepless nights and diaper changes.

A complication during delivery or need for special baby care for any reason only adds to the load, of course, sometimes necessitating the baby to be whisked away from mom and cared for in a limited-access room or in another hospital by nurses and doctors for days or weeks beyond the baby’s birth. But today, there is a growing effort to keep mom and baby together and encourage parental caregiving even with babies who are quite sick, a trend some experts refer to as “family-centered care.”

Focusing on the family

Family-centered care’s main tenet is that “the family is critical to the child’s well-being and future development,” says William H. Edwards, M.D., professor and vice chair of Pediatrics, medical director of CHaD Nurseries and sectionchief of Neonatology at Dartmouth-Hitchcock Medical Center. It is becoming a guiding force in neonatology, or the care of newborns, as neonatology continues to evolve from a late-1960s focus on life-saving technology and a care model that grouped babies together, but apart from parents, to today’s emphasis on family bonding and parental involvement.

The family-centered care movement in neonatology took hold with cases of healthy newborns, became more accepted in cases where the baby required intermediate care and is now moving into critical care situations, Edwards says. “We’re recognizing the importance of parents’ presence, even when children are quite sick.”

The increasingly popular family-centered care approach maintains that a newborn’s parents at the hospital should be regarded as partners in care, as opposed to visitors or stressed family members who are too much in need of care and support themselves to be active participants in the healing process, says Edwards, unless circumstances are

extreme, such as when the child is critically ill or dying. “When we’re in the mode of promoting the baby’s health and nurturing and growth and development,” the parents should have a prominent role as caregivers before the baby is ready to go home, he says.

To foster more parental involvement in newborn care, some U.S. hospitals are developing special care nurseries that feature “neonatal couplet care,” enabling mother and baby to stay together from birth until discharge, says Brenda Neff, M.S.N., R.N.C., director of Maternity/Newborn Services at Catholic Medical Center in Manchester. “Currently what happens now across New England is that if a baby’s born sick or premature they go directly to the NICU [neonatal intensive care unit], so mom and baby can be separated for sometimes hours or even days, depending on if the baby needs to be transferred to another facility,” Neff says. With couplet care, mother and child stay in a private room together, where they both receive the care they need.

“When mom is ready to be discharged,” Neff says, “the baby then gets moved into the special care nursery, where there’s a bed right next to the baby’s bed space, so mom can sleep there.” Some hospitals, including CMC, even have family spaces with a living room, full kitchen, bathroom and laundry facilities to help families to stay in the hospital and be near the baby for “as long as they want,” Neff says.

In addition to convenience, the living arrangements offer more privacy to families, helping to promote breast feeding and family bonding. They also make it easier to keep environmental factors, such as lighting and noise levels, in check to help avoid sensory overload for the baby. “All of our special care nursery rooms are single-family rooms, which is different from the traditional open-room concept where you get a bunch of babies in one room,” Neff says. “We really look at the baby’s cues and respond to them instead of trying to get the baby on our schedule.”

Partners in caring

The neonatal couplet care approach makes parents partners in the care-giving process. “Parents do the majority of all of the hands-on care” at CMC, Neff says, “from weighing, bathing and helping with tests and procedures.”

If you’re the squeamish type who has no desire to get overly involved with hospital procedures, don’t worry — parental participation only stretches so far, and generally includes things related to feeding and nurturing the baby or promoting development. Families do not give the baby shots or hook up IVs, Edwards says.

But including parents in some care-giving duties is beneficial in many ways and allows them to tune in to their baby’s cues, Neff says. “When they bring their baby home, they know their baby really well,” rather than feeling like the baby is a stranger who’s been cared for by someone else since birth.

Some hospitals also include parents during rounds and shift changes, when information is being exchanged among medical personnel, further encouraging parents to be active participants on the caregiving team, Edwards says. As parents interact with their baby, hospital staff members can provide coaching, offering tips and knowledge that parents might not be as likely to acquire in a traditional hospital setting.

Enabling families to room in at the hospital and be full partners in care boosts parental confidence, Edwards says.

Traditionally, “there’s a very high readmission rate for kids who start out with intensive care,” he says. “I believe that has a lot to do with a lack of confidence in the parents” concerning issues they might encounter when they bring baby home.

The family-centered care philosophy also usually includes other efforts to ease the family’s transition to home life by engaging the pediatric community and other local resources so that support will continue as seamlessly as possible after discharge, Edwards says. NH

Hey, go easy on mom According to a field of study called epigenetics, environmental factors — such as diet, stress and, yes, parental influences — can activate chemical switches that regulate an individual’s gene expression, starting pretty much upon emergence from mom’s womb.

Research shows that “the type of parenting that we receive as newborns affects us long-term,” says Brenda Neff, director of Maternity/Newborn Services at Catholic Medical Center. From infancy, “there are actually changes at the genetic, DNA level, based on the influences in our environment. There are differences in stress responses based on the type of parenting that newborns receive.”

Research also shows, however, that outcomes can change as the environment changes, Neff says. “The effects of the environment are not hard-wired in, but they definitely do affect the genes.” So if we screw up as parents, but we fix our mistakes, there’s hope for our offspring? “Exactly,” Neff says.