Parents as partners in care

2017 Neonatal Conference talk preview

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Valuing parents as partners in the care of their baby is at the core of the Baby Friendly Initiative neonatal standards. In this guest blog, Neonatal Speech and Language Therapist and Lactation Consultant Annie Aloysius  gives a preview of her 2017 Neonatal Conference talk – highlighting the vital importance of empowering parents to care for their baby, both for their own wellbeing and, crucially, for the health and life chances of our most vulnerable babies.

Neonatal care has traditionally focused on saving the lives of sick and premature babies, and the technology to support this has become increasingly advanced. Outcomes have improved dramatically and now a good proportion of even the smallest premature babies will survive with good outcomes. Over the years, developments and initiatives have focused solely on the wellbeing of the baby, with little emphasis on how care impacts the family. Many are becoming parents for the first time, and having to adapt to their new roles within this highly technical environment can be daunting. If we are to continue to improve outcomes for the baby we now know that it is essential that the parents are fully involved as true partners in their baby’s care. As Donald Winnicott wisely said: “there is no such thing as a baby … there is a baby and someone.”

Bliss’ 2015 Hanging in the Balance report explored the progress being made in neonatal care and found that having a baby born premature or sick is a very anxious, stressful and traumatic time for parents, and they often need emotional support to help them cope. Parents are more likely to experience mental health problems, and up to 40% of mothers of premature babies are affected by postnatal depression, with a significant proportion of parents also being affected by post-traumatic stress. The report noted that 41% of units have no access to a trained mental health worker and in 30% of units parents have no access to any psychological support at all. National neonatal staffing shortages, coupled with a lack of psychological support and facilities for parents leave many families without the emotional support they need, making it harder for them to be involved in their baby’s care.

Improving this experience, however, can be a challenge for neonatal staff. Creating an environment that nurtures and helps parents to build a close and loving relationship with their baby is complex. As well as staffing and resourcing issues, the culture within the neonatal unit and how parents are supported can create opportunities for parents or pose further barriers to helping them in their transition to parenting.

Nurturing and nourishing babies on the neonatal unit

There are a number of initiatives that can benefit vulnerable babies and their families, and often little changes in practice can help to make a big difference. The Baby Friendly Initiative neonatal standards support units to make these changes to ensure the best outcomes.

Standard 1: Support parents to have a close and loving relationship with their baby

Ensuring the family have early skin-to-skin cuddles as often as they can helps them to get to know their baby, gives them the confidence to touch, hold and love their baby and assures them that their baby is in the warmest, safest place. But they need space, time and privacy to do this and at the very least a comfortable chair. When parents spend time close to their baby they begin to get to know and love their baby and develop an understanding of the benefits of this close, loving contact. These special times support their baby’s brain development and help them to build a strong, lasting bond.

Standard 2: Enable babies to receive breastmilk and to breastfeed where possible

Valuing breastmilk and supporting the early expressing of colostrum gives an instant and essential role for a mother in the care of her baby. Those drops of colostrum are the crucial thing that only she can provide for her baby; our role is to ensure that she is enabled to provide this. A mother needs information on how to express breastmilk, syringes to collect it and guidance on how every drop can be used to support her baby’s growth, development and wellbeing. She can be supported to offer her baby early tastes during mouth care, moving on to tube feeds coating and protecting their immature gut and filling their tiny tummy, and then helping the baby to attach at the breast for the first time and to learn how to suck and swallow.

Standard 3: Valuing parents as partners in care

Inviting parents into the unit to provide care for their baby requires a shift in culture and how we view them. They are not visitors, they are the parents; neonatal staff are there, temporarily, to support the parents to care for their baby. To enable this, parents need open access, 24-hours a day, seven days a week. This requires a shift in the way we have traditionally worked; away from making parents leave during ward rounds and procedures to thinking about ways they can stay near their baby and be involved. There have been a number of projects developed using headphones for this purpose.

When parents are valued as true partners in their baby’s care and given support and education, they are able to carry out a significant proportion of their baby’s care; from mouth care and changing nappies to tube feeding and giving medications. When parents are doing this they are able to tell us best how the baby is behaving and doing; parents are essential members of the medical ward rounds, helping to understand their baby’s condition and make decisions alongside the neonatal team.          

Imperial College Healthcare NHS Trust are one of a number of centres across the UK who are working to put parents right at the heart of their baby’s care. We are working towards Unicef UK Baby Friendly Initiative neonatal accreditation and as part of this process are formalising a model of Family Delivered Care which will be regularly evaluated to explore its impact. Our conversations with parents who have experienced life on the neonatal unit are highlighting the need to educate, engage, empower and enable parents to be the experts in their baby’s care so that when they leave hospital, rather than wishing we could come home with them, they leave feeling in control and empowered to care for their baby with confidence as a family unit.

Follow our project developments and learn about our new resources on our Integrated Family Delivered Neonatal Care Facebook group. For more details, contact Annie.aloysius@imperial.nhs.uk