Mindfulness-Based Strategies: A Cost-Effective Stress Reduction Method for Parents in the NICU

Adaptation of SafeCare, an evidence-based parenting program, for caregivers of infants in the neonatal intensive care unit

BACKGROUND

While there are several parenting programs for NICU caregivers, no studies, to our knowledge, have developed parenting programs aimed at preventing child maltreatment that specifically address these parental factors: parental stress, parental self-efficacy, and positive parent-infant interaction.

OBJECTIVES

The objectives of this study were to: 1) Identify adaptations and/or augmentations needed to optimize SafeCare® for NICU caregivers, and 2) Examine the acceptability and preliminary effects of the adapted SafeCare NICU (SCNC) program with NICU caregivers.

METHODS

This study consisted of two phases: formative (phase one) and pilot (phase two). For phase one, 5 NICU former caregivers and 5 NICU staff were interviewed to make relevant, NICU-specific adaptations for SCNC. Phase two consisted of a pilot study, where 13 current NICU caregivers were enrolled in the adapted SCNC program. Outcomes included acceptability and preliminary effects of parental stress, parental self-efficacy, and parent-infant interaction.

RESULTS

Adaptations to SafeCare consisted of adding a pre-session to discuss individualized experiences, incorporation of adjusted developmental milestones, a NICU-specific resource sheet, and individualized adaptations to activities based on relevant medical concerns. Out of the 13 participants, 8 completed SCNC (61.5 % retention rate). Participants indicated significant reductions in stress after SCNC (Parental stress index score = 61.7) compared to baseline (79.2, p = 0.02). Among participants who completed SCNC (n = 8), all stated they supported this program for implementation among NICU caregivers.

DISCUSSION

The adapted SCNC demonstrated acceptability among NICU caregivers.

Mindful Kangaroo Care: mindfulness intervention for mothers during skin-to-skin care: a randomized control pilot study

Background

Parents of babies admitted to the Newborn Intensive Care Unit (NICU) undergo considerable stress. There is evidence that mindfulness reduces stress in these parents. Kangaroo Care (KC) is practiced in NICUs across the world and is stress-relieving. Whether mindfulness practiced during KC in the NICU reduces parental distress has not yet been studied. The objective was to explore the feasibility and acceptability of teaching and practicing mindfulness during KC for mothers of premature babies. The objective was also to document preliminary outcomes of Mindful Kangaroo Care (MKC) on maternal stress, anxiety, depression, and mindful awareness.

Methods

In this pilot randomized controlled study, mothers of premature babies who were expected to stay in the NICU for at least four weeks were taught two mindfulness exercises to practice during KC and compared to mothers who received standard care with no mindfulness teaching. Mothers filled out stress, anxiety, depression and mindful awareness scales at recruitment and after four weeks. Acceptability and feasibility questionnaires were also completed.

Results

Fifteen mothers per group completed the study. The MKC group demonstrated a significant within-group reduction in anxiety (p = 0.003), depression (p = 0.02) and stress (p = 0.002), and a significant increase in both the curiosity (p = 0.008) and decentering (p = 0.01) scores of the Toronto Mindfulness Scale, all of which had medium to large effect sizes. Only the increases in curiosity and decentering were significant between groups. Fourteen mothers found the intervention acceptable, one neutral.

Conclusion

MKC was acceptable, feasible and led to a reduction in stress, anxiety and depression in mothers who practiced mindfulness exercises during KC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04336-w.

Maternal postpartum depression: risk factors, impacts, and interventions for the NICU and beyond

PURPOSE OF REVIEW

Postpartum depression (PPD) negatively impacts caregivers, infants, siblings, and entire families. Mothers with infants admitted to the neonatal intensive care unit (NICU) face additional risk for PPD, coupled with risk factors extending beyond a NICU admision. The novelty of this review is the focus on maternal PPD for mothers with infants admitted to the NICU. Interventions aimed at limiting and preventing PPD in this population include: prenatal and postpartum depression screening, PPD symptom awareness and monitoring, and trauma-informed care.

RECENT FINDINGS

PPD, the most frequent complication of childbirth, affects approximately 10-15% of mothers worldwide. Prevalence rates increase to 40% for mothers whose infant is admitted to the NICU. PPD can affect maternal and child health across the life course and predispose future generations to a myriad of developmental, psychosocial, and physical challenges. Prevalence rates are higher for racial and ethnic minorities, immigrant and refugee populations, and mothers in rural locations. Trauma-informed care is suggested at individual and organizational levels, leading to better care for those with and without previous trauma exposure.

SUMMARY

Increasing PPD symptom awareness, screening for PPD, and connections with resources should begin during prenatal visits. Care teams should discuss barriers to resources for mothers, children, and families to improve access and support.

Promoting Family and Siblings' Adaptation Following a Preterm Birth: A Quality Improvement Project of a Family-Centered Care Nursing Educational Intervention

BACKGROUND AND PROBLEM

A Family-Centered Care (FCC) quality improvement project was implemented with nurses to promote families' and siblings' adaptation during the NICU hospitalization of a preterm infant. The objective of this quality improvement project was to compare the nurses' knowledge and perceptions as well as their implementation of nursing practices to facilitate the families' and siblings' adaptation during NICU hospitalization before and after they received the FCC educational intervention.

METHODS AND INTERVENTION

A pre- and post-intervention evaluation design was used in this quality improvement project. A convenience sample of 20 nurses was initially recruited and completed the pre-intervention, while 13 completed the post-intervention. The educational intervention included a reflective practice exercise and a face-to-face training session. Nurses completed a self-administered questionnaire with two subscales assessing their knowledge, perceptions, as well as their implementation of nursing practices related to family and sibling adaptation in the NICU.

RESULTS

The paired samples t-test shows Paired-samples t-test showed that the nurses' knowledge, perceptions and implementation of nursing practices were more favorable following the FCC educational intervention.

CONCLUSIONS

Findings of this quality improvement project reinforce the value of supporting NICU nurses with educational training programs to enhance their practice. This educational intervention represents an effort to foster the implementation of FCC in NICUs.

Historical Perspectives: Unsilencing Suffering: Promoting Maternal Mental Health in Neonatal Intensive Care Units

Mothers of infants in the NICU suffer higher rates of psychological distress, anxiety, and depression compared with the general population. Often, their mental health concerns remain underidentified and undertreated, which can have deleterious effects on the offspring, both in short-term outcomes while in the NICU as well as long-term neurodevelopmental and behavioral outcomes. In this review, we present an overview of existing empirical evidence about how maternal mental health affects the health of infants, special considerations regarding the mental health needs of NICU mothers, and the findings about existing and developing interventions to address mental health concerns in this vulnerable population.