Clinical Fellow Yale - New Haven Hospital New Haven, Connecticut, United States
Background: The environment of the Neonatal Intensive Care Unit (NICU) provides many sources of parental stress, which is associated with delayed lactogenesis and decreased rates of breastfeeding. While mother and infant co-care in the well-baby nursery reduces maternal and infant stress and improves breastfeeding rates, little is known about these associations in the NICU.
Objective: The aims of this prospective, observational, mixed-methods study were to describe and compare experiences of stress during post-partum admission, as measured by the different domains of the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU), and breastfeeding among mothers who received NICU couplet care and mothers who qualified but did not receive it.
Design/Methods: Mothers were recruited after infant birth if both mother and infant met the clinical criteria for couplet care, the infant required ≤ 1 LPM, and the infant was < 1 day old. After completion of informed consent, mothers completed the PSS:NICU. Maternal and infant data was extracted from the medical record, and breastfeeding status was assessed through 6 months by maternal report.
Results: Of the 25 mothers (12 Non-Hispanic White, 3 Non-Hispanic Black, and 6 Hispanic) who participated in the study and intended to breastfeed, 17 (58%) experienced couplet care. Mothers in both study groups reported the highest stress scores in the domain of parent-infant relationship. Maternal qualitative feedback focused largely on environmental stressors in the NICU, such as lights and sounds from monitors. Infants in couplet care received a greater proportion of in-hospital feeds from maternal milk (48% vs. 15%, p=.0011). Couplet care was also associated with increased proportion of feeds given by parents versus staff (69% vs. 21%, p=.0004). Of the 16 (64%) mothers with follow up data, 9 (56%) were still breastfeeding, 7 (78%) of whom received couplet care. Conclusion(s): Our study identifies potential sources of maternal stress during an infant’s NICU admission, particularly factors that alter the infant-parent relationship. Despite the presence of common NICU stressors, our findings suggest a beneficial effect of mother and infant co-care on breastfeeding rate during the hospitalization and post-discharge. Ongoing investigation into in-hospital and long-term outcomes of the NICU couplet care experience is important as it may inform improvements in maternal and infant post-partum care.
Authors/Institutions: Caitlin Nichols, Yale University, New Haven, Connecticut, United States; Kimberly N. Doughty, Fairfield University, Fairfield, Connecticut, United States; Christine Henry, Yale University, New Haven, Connecticut, United States; Veronika Shabanova, Yale University, New Haven, Connecticut, United States; Taryn Zamary, Yale University, New Haven, Connecticut, United States; Sarah Taylor, Yale University School of Medicine, New Haven, Connecticut, United States