A Mother’s Power in the NICU

 

A mother is a unique individual.  We can all undoubtedly think of some or many powerful impacts our own mothers had in our lives.  I often think of the difficult situation the mothers and fathers are in while their infant is in the NICU.  After dreaming of and caring for this little human, suddenly, in many cases, the infant is delivered before they are prepared. 

They must adjust their expectations instead to focusing on how their infant is doing in the NICU….did he gain weight today?  Did she tolerate a decrease in the ventilator?   Will they be able to hold him?  Or will she be too unstable today?  Their lives become filled with trips and phone calls to the hospital instead of packing diapers and car seats to visit friends.  It reminds me of the story of the mother who had an infant with a birth defect and compared it to planning a trip to Italy.  She imagined spending many hours researching, dreaming and planning this perfect trip to Italy but when she got off the airplane, she realized she was in Holland!!  Not that Holland is a bad place, it just wasn’t where she had planned or was prepared to go!!  The same can be said of having a preterm infant who spends months in the NICU…eventually, in most cases, you will get to Italy but instead of a direct flight, you end up taking planes, trains and automobiles, with delays and side trips along the way.

Sometimes, parents have a difficult time coming in to visit.  The infant may be particularly sick and I’ve even heard some parents say that they feel as though they are in the way, particularly during this time.  However, we know that mothers, in particular, have an effect on their infant that good medical and nursing care does not.  There have been many instances, both animal and, unfortunately human, where infants are removed from maternal contact altogether and suffer irreparable psychological damage, and sometimes physical such as failure to thrive.  One way we can help mothers whose infants are in the NICU is to point out the value their mere presence has on their infant.  Small things like softly holding their hand or foot may calm some infants.  There are several studies now showing the benefit of skin to skin care with both mothers and fathers.

Providing breast milk for these fragile infants is something unique to a mother.  We know that mother’s own milk has unique properties suited to her infant.  While donor milk is an attractive alternative, it can never take the place of the mother’s own milk nutritionally.  During the time that the infant is particularly sick, providing the breast milk is most important and a unique thing that mothers can do for their infant.  I have seen many women over the years that don’t intend to provide breast milk, but once the benefits are explained, will start pumping.  Some only provide milk for a short time, but many continue to provide milk past discharge.  The most important benefits for preterm infants are avoidance of feeding intolerance or necrotizing enterocolitis and provision of antibodies that improve immunity.  We now know that the benefits of human milk are not just short-term benefits and are dose dependent.  That is to say that the more milk (long term) the infant receives, the greater the benefit.  Many benefits are manifested in adulthood such as decreased incidence of obesity and diabetes (both type I and II).

One recent study showed benefit to use of a pacifier activated maternal voice device which resulted in improved oral feeding skills, without which many infants remain hospitalized.1  Use of a pacifier has already been shown to decrease signs of pain/stress in the newborn.  Krueger, Parker, Chiu & Theriaque studied the effect of maternal voice on feeding intolerance in two different age groups.2  They found that feeding intolerance was decreased more in the lower gestational age group, perhaps indicating that it was more important for the more fragile infants where feeding intolerance is more common.

So, not only is the breast milk important to decrease feeding intolerance but the presence of the mother.  Unfortunately, in the NICU, maternal presence is often substituted with maternal voice recordings to meet these same goals.  Either way, mothers should feel quite important in their infant’s lives right from the beginning.  The effect on their lives starts even prenatally with the mother’s overall health and avoidance of exposure to various substances and drugs that may change the infant’s development.  But, one thing that I find quite common in mothers whose infants have anomalies or birth defects, is that the mother often feels some blame for this whether grounded in fact or not.  In most cases, this is not through any maternal health condition or behavior.  At that point, we must help her realize that her plane has now landed in Holland rather than Italy, and how to make the most of her journey.

References:

1. Chorna OD, Slaughter JC, Wang L, Stark AR, Maitre NL.  A pacifier-activated music player with mother’s voice improves oral feeding in preterm infants.  Pediatrics. 2014; 133:462-468. doi:10.1542/peds.2013-2547

2. Krueger C, Parker L, Chiu S-H, Theriaque D.  Maternal voice and short-term outcomes in preterm infants.  Dev Psychobiol. 2010 March ; 52(2): 205–212. doi:10.1002/dev.20426

 

Looking for additional reading from Sandy Beauman’s professional perspective?
View her blog entry Neonates and Their Future: Neurodevelopmental Outcomes.
Click here to read the full blog entry.