Antepartum Education and Empowerment Program: Decreasing Stress and Promoting Parent Attachment Prior to a NICU Admission
Amanda Mock, MSN RNC-NIC, NIDCAP Professional
Ariane Dobson, MSN RNC-NIC, NIDCAP Professional
Having a baby in the neonatal intensive care unit (NICU) is one of the most difficult experiences a parent can go through. An increasing amount of evidence validates the argument that the experience of having an infant hospitalized in the NICU can lead to significant risk for acute stress disorder (ASD), post-traumatic stress disorder (PTSD), and postpartum depression (Purdy et al., 2017; Shaw et al., 2009, Woodward et al., 2015). High levels of parental stress in the NICU can lead to impaired bonding and has been shown to have long-term effects on neurodevelopmental outcomes (Purdy et al., 2017; Woodward et al., 2015). Research has shown that nurses can have a positive impact on parental stress and anxiety through the use of education, starting with a mother’s admission to the antepartum unit (Morey & Gregory, 2012).
The Antepartum Education and Empowerment Program was created out of an identified need to send consistent information to parents prior to a NICU admission and the desire to address maternal mental health early. NICU mothers report a loss of parental role and feelings of powerlessness as major sources of stress (Purdy et al., 2017; Woodward et al., 2015). Higher levels of maternal stress are seen in mothers admitted to the hospital for long periods of time before delivery (Pichler-Stachl et al., 2016; Thorman & McLean, 2006). Although mothers received consultations with neonatologists and other specialists while in the antepartum unit, the focus of those consultations were frequently medical interventions and statistics of survival rather than what the NICU experience would look like. Following the medical consultations, parents often were left with questions about day-to-day life in the NICU and what they, as parents, could do for their baby.
To streamline the process and provide accurate and consistent information to families, the Antepartum Education and Empowerment Program was developed. The two goals of the Antepartum Education and Empowerment Program include educating parents so they are familiar with the NICU environment and equipment and empowering parents to feel confident in caring for their baby while in the NICU and after discharge.
Each morning, a NICU developmental specialist attends daily multidisciplinary antepartum rounds. Here, at-risk mothers are identified. These mothers include those who are in jeopardy of premature labor, premature rupture of membranes, multiple gestation pregnancy, pregnancy-induced hypertension, or known congenital birth defects. A NICU developmental specialist then meets with the family in their antepartum room and arranges a time to present them with the appropriate educational materials.
The educational material booklet begins with an overall view of life in the NICU. Details on visitation, a description of the unit layout, and pictures of unit-specific medical equipment are presented first. The next section focuses on the baby’s developing brain and neurodevelopment, including the importance of sleep, clustered care times, kangaroo care, prefeeding skills, and developmental positioning. The booklet includes a discussion of the role of parents of a NICU baby and the emotional “roller coaster” they may be feeling or may experience. Parents are empowered with the knowledge that they are the most important people in the infant’s life. Tangible tasks they can do for their baby in the NICU, such as providing breastmilk, participating in skin-to-skin care, getting to know their infant’s cues, and bonding with their baby are highlighted. Finally, a NICU “dictionary” is included in the booklet with pictures of actual preterm babies showing common medical supplies such as EKG leads, pulse oximetry probes, nasogastric tubes, oxygen cannulas, endotracheal tubes, etc. Several common terms such as corrected gestational age, apnea, and bradycardia are defined in this section as well. In addition, a resource list of videos and recommended websites are provided.
A NICU developmental specialist sits with the parents and goes through the booklet page by page to answer any questions that may arise. Following the presentation of the Antepartum Education Handbook, there is a discussion about the daily routine in the NICU. A sample day in the NICU is explained, and the value of the role of parents is clarified. Questions are encouraged throughout this one-on-one education program. After the session, a NICU tour is offered to the family as long as the mother is medically stable. The mother then visits the NICU accompanied by her support person. The family is shown how to navigate the obstetrics unit and the process of entering the locked NICU department. During the family tour of the NICU, the parents are familiarized with the different pods, pumping room, parent lounge, and nesting room. The equipment they were exposed to in the booklet is pointed out and explained. With parental consent, a current patient near the same gestational age is then introduced to the parents. Finally, the family meets staff members and learns their NICU roles. Questions are answered, and the mother is escorted back to her antepartum room.
Informal feedback was collected to assess the success of the program at meeting the stated goals of educating families and providing psychosocial support and parental empowerment to mothers during their antepartum stay. The first goal included educating parents so they are familiar with the NICU environment and equipment. Parents reported feeling more comfortable knowing what some of the equipment looked like and were not as nervous to see this equipment on their baby or at their baby’s bedside. Parents also reported that they appreciated touring the NICU before their baby was admitted so they could imagine their baby in a certain pod or bed space upon admission if they were not able to immediately visit. Of note, parents provided feedback that they enjoyed meeting a developmental specialist prior to delivery. They felt a sense of comfort and trust with this person helping to ease the transition to the NICU that continued throughout their NICU stay.
The second goal of the program was to empower parents to feel confident in caring for their baby while in the NICU and after discharge. Parents reported increased comfort learning about tangible things they could do for their baby. Parents also felt better knowing the important role they play in their child’s journey.
Future goals for the Antepartum Education and Empowerment Program include an institutional review board approved research study. This study will investigate the role of the Nurse-Led Antepartum Education and Empowerment Program in the reduction of maternal stress and increased maternal knowledge specific to the NICU. The second goal is to offer the Education and Empowerment Program on an outpatient basis. This will be done by collaborating with maternal-fetal medicine specialists to identify families with a high probability of NICU admission. This includes families diagnosed prenatally with congenital birth defects or high-order multiples.
As research mounts in the validation of the acute and long-term stress that parents face as a result of their baby’s stay in the NICU, it is important to mitigate the effects by educating and empowering parents to care for and connect with their infants, both during their NICU stay and beyond.
Morey, J & Gregory, K. (2012). Nurse-Led education mitigates maternal stress and enhances knowledge in the NICU. The American Journal of Maternal/Child Nursing, 37(3), 182-191.
Pichler-Stachl, E., Pichler, G., Baik, N., Urlesberger, B., Alexander, A., Urlesberger, P., Cheung, P.Y., Schmölzer, G. M. (2016). Maternal stress after preterm birth: Impact of length of antepartum hospital stay. Women and Birth, 29(6), e105-e109. https://doi.org/10.1016/j.wombi.2016.04.008
Purdy, I. B., Melwak, M. A., Smith, J. R., Kenner, C., Chyffi-Siewert, R., Ryan, D. J., Geller, P. A., & Hall, S. (2017). Embracing EBP recommendations to provide parent psychosocial support. Advances in Neonatal Care, 17(1), 33-44.
Shaw, R. J., Bernard, R. S., DeBlois, T., Ikuta, L. M., Ginzburg, K., & Koopman, C. (2009). The relationship between acute stress disorder and posttraumatice stress disorder in the neonatal intensive care unit. Psychosomatics, 50(2), 131-137.
Thorman, K. & McLean, A. (2006). While you are waiting: A family-focused antepartum support program. The Journal of Perinatal & Neonatal Nursing. 20(3), 220-226.
Woodward, L. J., Bora, A., Clark, C. A., Montgomery-Honger, A., Pritchard, V. E., Spencer, C., & Austin, N. (2014). Very preterm birth: maternal experiences of the neonatal intensive care environment. Journal of Perinatology, 34(7), 555-561.