Perceptions and actions of healthcare professionals regarding the mother-child relationship with premature babies in an intermediate neonatal intensive care unit: a qualitative study

Abstract

BackgroundThe mother-child interaction after delivery may be hampered when the newborn baby is hospitalized. The objective of the study was to understand perceptions and actions of healthcare professionals (HCPs), working in an intermediate neonatal intensive care unit (NICU), regarding mother-child relationship of hospitalized premature babies in the first weeks after delivery and the professionals’ support for the development of this relationship within an NICU environment. The psychoanalytic concept of holding defined by Winnicott was used as the theoretical framework.MethodsA qualitative study was conducted with 20 HCPs (physicians, medical residents, nurses, and nurse technicians) working at an intermediate NICU of a referral hospital in Brazil. Semi-structured interviews were conducted, recorded and transcribed verbatim; and thematic analysis was performed.ResultsThe HCPs referred to the difficulty that these mothers had to develop the mother-child relationship within this environment. If they observed that the mother had initial inhibitions to interact with her baby, they tried to facilitate this process, since they were aware of the importance of early bonding for the child’s well-being. They attributed the mothers’ difficulty to the fragile appearance of the premature baby, the limited contact often imposed by the routine of the unit and the lack of participation in the decisions regarding the care given to her baby. HCPs tried to help women bond with her child by giving support and encouragement. Most of the physicians reported that the nurses represented a link between physicians and the mothers of the hospitalized babies.ConclusionThe HCPs reported attitudes and actions indicative of holding. A more in-depth understanding of the relationship between HCPs and mothers of premature babies at an NICU during the first days after delivery, and the needs of the mothers and her baby to be close to facilitate bonding should be part of the routine discussions of the NICU health team.

Experiences of Families of Premature Children in a Neonatal Intensive Therapy Unit

“…5 Além do sofrimento pela separação, fragilidade do prematuro e da família, a condição também impõe a necessidade de disposição para estar ao lado do neonato. Para acompanhá-lo durante o internamento, os familiares precisam abdicar de parte do tempo de sua rotina a fim de conciliar a hospitalização com o contexto familiar 21 e dispor de boa condição financeira para custear transporte, alimentação e, em alguns casos, pagar um cuidador para ficar com outros filhos no domicílio.…”

“…2 O estabelecimento de vínculo entre pais e filho prematuro é essencial na unidade intensivista, uma vez que o contato físico e a interação, por meio da fala dos pais, com o RN, mesmo que rapidamente, implica benefícios para o seu crescimento e desenvolvimento. 5 Para o cuidado à família do prematuro, os profissionais de saúde precisam compreender as necessidades apresentadas pelos familiares para que possam planejar e promover assistên-cia eficiente no processo de formação de vínculo entre eles. Devem observar a singularidade de cada caso, envolvendo aspectos biopsicossocioculturais, pois cada familiar tende a reagir influenciado por sua cultura e vivências.…”

Vivência de mães de bebês prematuros do nascimento a alta: notas de diários de campo

“…Being the mere bystander of the baby's care makes mothers feel deprived of their maternal function, unable to recognise themselves as mothers, and often unable to accept and acknowledge their child since a team has appropriated that care that a priori she should be providing. At present, it is not uncommon for mothers to harbour feelings of worthlessness, failure, and inferiority (2,4,6) . In view of this delicate stage faced by mothers and families, any possibility of bonding with the baby can be compromised, causing disorder in the mother-child relationship.…”

“…In view of this delicate stage faced by mothers and families, any possibility of bonding with the baby can be compromised, causing disorder in the mother-child relationship. Thus, facilitating the approximation of parents with their child supports the establishment of emotional ties and, consequently, capacitates mothers to care for their child (6)(7)(8) .…”

“…It is known that a good relationship between parents and the nursing staff is essential to encourage bonding and the permanence of the parents in the ICU during the period of hospitalisation of preterm infants (6,8) . Based on this premise, a growing number of studies have used qualitative methods to explore what the health team can do to help parents during the stay of babies in the neonatal unit, and to highlight areas of particular importance for their care (1)(2)9) .…”