Early mother-neonate contact and the mother-child relationship

Variation in referring newborns to special care in Finland

We studied the frequency of referring newborns to special care in Finland and its variation between hospitals. Data was obtained from the nationwide Finnish Birth Register for 1991 and 1994. Newborns who during their first week of life had been in special care, in another hospital, in a respirator, or who had received a blood exchange were defined as having been in special care. This applied to 7% of newborns in 1991 and to 8% in 1994. The proportions of newborns in special care varied notably between hospitals of the same level. The differences could be explained by varying patient mixtures and different thresholds for referral to care. The indications for referring newborns into special care, especially in hospitals with high rates of referral, requires scrutiny.

Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding

BACKGROUND

Postnatal Depression has demonstrated long-term consequences on child cognitive and emotional development, however, the link between maternal and child pathology has not been clearly identified.

OBJECTIVE

This study examined whether maternal bonding to the infant and young child is impaired by maternal depressive symptoms.

METHODS

101 mothers of newborn infants were recruited from local obstetric units and examined for psychopathology using Symptom Checklist, the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Questionnaire at two weeks, six weeks, four months and fourteen months postpartum.

RESULTS

Maternal depressive symptoms at 2 weeks, 6 weeks and four months postnatally but not at fourteen months of infant's age were found to be strongly associated with lower quality of maternal bonding to the infant and child from two weeks until fourteen months of postnatal age. Even mild and unrecognized maternal depressive symptoms had a significant impact on maternal bonding, if they occurred during the first four months of life.

CONCLUSIONS

This gives reason for increased concern for mother-infant dyads in the first few months after birth that could be regarded as a highly sensitive period for the development of the mother-child relationship. The findings warrant further studies and inspire the development of preventive programs focussing on infant and early childhood mental health by emphasizing protection and support during the first critical months.

Skin to skin contact for very low birthweight infants and their mothers

Separation between mothers and very low birthweight infants is often prolonged with subsequent psychological distress, behaviour problems, and lactation failure. Babies as small as 700 g, who no longer require oxygen, can be safely and enjoyably held naked, except for a nappy, between the mother's breasts for up to four hours a day. We have carried out a randomised trial among babies less than 1500 g. Seventy one infants were randomised. In 35, the mother was helped to hold her baby in skin to skin contact and encouraged to do so whenever she visited the baby. In 36, the mother was encouraged to handle her baby but without skin to skin contact. Mothers using skin to skin contact lactated for four weeks longer on average than the control group. At 6 months of age the infants who had skin to skin contact cried significantly less than the control group. Skin to skin contact can safely and enjoyably be offered to very low birthweight infants especially in developing countries where the mother's lactation is vital.

The interaction between the infant and the environment: the importance of mother-child contact after delivery

Birth is more than just the physical beginning of a new life--it is also the start of the psychosocial development of the newborn infant together with its family. Immediately after delivery parents and infants can start to exchange signals that maybe are of major importance for this development. The early post partum period has been regarded to have great potentials and especially the mother has been regarded to play a very powerful role, whereas the infant's contribution has been accorded little discussion. The individual reactive capacity of the newborn baby and its influence on the environment can be illustrated in a number of ways. In recent years studies of fetal movements have been made by means of ultra sound registration and it has been discussed whether these are precursors of later behavior in the neonate-infant. The transition at birth can be considered either to be continuous or dis-continuous, the outcome of this discussion has great bearing on the importance of early neonate-environment interactions. Short and long term outcome of different routine care procedures around the time of delivery and transition are controversial subjects. Although several studies support the importance of early post delivery interaction, other studies do not seem to find correlations between early experiences and later developmental outcome measurements. In this paper several of these aspects will be discussed, examples from the literature given and possible clinical applications suggested, as well as their impact on the care of healthy and sick newborns and their families.

Children at risk: perinatal events, developmental delays and the effects of a developmental stimulation program

This paper reports the findings of two studies done between 1977 and 1981 in the Philippines. The first study examined the performance of 911 children, with histories of perinatal risk events, on a restandardized Philippine (Metro-Manila) version of the Denver Developmental Screening Test (DDST) which was developed in 1980. This study established that the children performed significantly below Philippine norms. A second study, cognizant of the findings of the first, introduced nursing interventions designed to address some needs of preterm infants and their mothers. Findings suggest that development stimulation can significantly improve the developmental status of preterm infants.