Effects of Prematurity on Bonding

A Study at KATH MBU

Group Members
Appiah Boateng Edward
Agyemang Serwaa Linda
Antwi Opoku Ernest
Introduction Background to the Study

 Premature infants have an especially hard time dealing with the

transition from their intrauterine environment into the world
because they many times are not yet adapted or able to live
outside the womb.

 The Neonatal Intensive Care Units (NICUs) are designed to

meet the medical needs of these infants by providing oxygen,
gastric tubes, incubators, etc.

 Bonding is the formation of a mutual emotional and

psychological closeness between parents or primary caregivers
and their newborn child (Linwood, 2006).
Introduction Background to the Study

 Complications may alter bonding somehow. Mother or baby

may spend some time in intensive care, as in preterm delivery,
and mother or father may be put off by the amount and
complexity of equipment (Weiss, 2008). The separation that is
brought about as a result of the baby’s admission to the NICU
tends to contribute greatly towards delayed bonding.

 9.3% of births in Korle Bu are preterm (Nkyekyer, Enweronu-

Laryea, and Boafo 2003)
Introduction Background to the Study Cont’d

Preterm deliveries at KATH from 2005 to 2007

Year

Deliveries 2005 2006 2007

Total 10743 10015 12318

Preterm 1343 1094 1200

% Preterm 12.50% 10.92% 9.74%

(Courtesy Reproductive Research Unit, Obstetrics and Gynecology
Department, Biostatistics Unit – KATH, 2008)
Introduction Background to the Study Cont’d

Studies of newborn monkeys who were given mannequin

mothers at birth showed that, despite the efforts of the baby
monkey to get a response through holding and touching the
mannequin, the lack of a parental response caused stunted
development, sadness, and failure to thrive in the young
monkeys. Scientists, therefore, suspect that lack of bonding in
human babies causes similar problems. (Homeier, 2005)

Prolonged hospital care intrudes upon maternal interactions

and mother-infant bonding, where interactions take place in a
newborn intensive care unit, often separating mothers and their
infants for longer periods of time, resulting in limited
opportunities for mothers to feed or nurture their preterm infants
(Goldberg & Divitto, 2002).
Introduction Background to the Study Cont’d

 Incubators and medical care, necessary for the infant’s

survival, is accompanied by physical separation between
the preterm infant and his or her parents. The immature
preterm infant is not able to interact with the parent in the
same way as the healthy infant, which includes sustained
eye contact and auditory orientation to the parents’ voice.
(Als, Butler, Kosta, McAnulty 2005).

 Medical procedures alone have been estimated to account

for the majority of social and physical contact a
premature infant endures whereas, mothers' account for a
mere 14 percent (Goldberg & Divitto, 2002).
Introduction Background to the Study Cont’d
 Feelings of anxiety, and fear that their infants will not survive or
survive with disabilities, as well as guilt, anger and helplessness may
influence negatively on the process of bonding and may be further
enhanced by the preterm infant’s weaker signals and lower alertness
and responsiveness. (Als et al, 2005; Eckerman, Oehler, Medvin,
Hannan 1994; Minde, Whitelaw, Brown, Fitzhardinge 1983)

 American pediatricians John Kennel and Marshall Klaus pioneered

scientific research on bonding in the 1970s. They experimented with
giving mothers of both premature and healthy full-term babies extra
contact with their infants, immediately after birth and in the few days
following birth. Mothers with more access to their babies in the
hospital developed better rapport with their infants, held them more
comfortably, and smiled and talked to them more often (Kennel and
Klaus, 1998).
Introduction Background to the Study Cont’d

 Kangaroo Care (also Kangaroo Maternal [Mother] Care

or Skin-to-Skin Contact and Breastfeeding) is a method
used to restore the unique mother-infant bond following
the sudden separation during the birth experience
particularly in premature births (Kirsten, Bergman, &
Hann, 2001).
Introduction Problem Statement

 In KATH, about 9 – 12% of babies delivered are premature

and many of these preterm babies spend an average of 5.7 –
8.6 days in the Mother and Baby Unit (MBU) where they
receive intensive care. Others spend weeks or months at the
MBU based on their general condition. While there, they are
separated from their parents. Mothers have scheduled visits
during which they express breast milk for their babies. (Child
Health Directorate, Biostatistics Unit, KATH, 2008)

 The problems, then, are: do mothers at the Komfo Anokye

Teaching Hospital’s Mother and Baby Unit (KATH MBU)
feel close to their preterm infants? Do the care patterns at the
MBU affect the bonding process?
Introduction Purpose of the Study

 It is evident that preterm infants may need to spend their first

few days of life in the Neonatal Intensive Care Unit (NICU). It
has also been established that bonding may be promoted by
contact between parents and their infant (Salariya 1990). This
study seeks to identify how admission of preterm babies to
KATH MBU affects the bonding process between the parents
and their preterm infant within the period of admission into the
MBU.

 Furthermore, recommendations, based on findings, would be

made to the appropriate body or authority.
Introduction Objectives

General
 This study seeks to identify how admission of preterm babies
to KATH MBU affects the bonding process between the
parents and their preterm infant within the period of admission
into the MBU.

Specific
 To assess parents’ knowledge on preterm delivery.
 To identify common concerns of parents of preterm infants
while on admission.
 To identify care patterns of preterm infants at the KATH
MBU.
Study Area
 Mother and Baby Unit, Komfo Anokye Teaching Hospital

Study Population
 forty mothers of preterm infants on admission who had spent,
at least, three days in the unit. Data collection period was from
5th to 20th of April, 2008.
 Selection of the mothers was by convenience sampling
method.
 Exclusion from the study was mothers of preterm infants with
other congenital abnormalities such as cleft palate, hare lip,
etc.
Study Design
 Non experimental study design
 Cross-sectional study design

Data Collection Tools

 Questionnaires
 Pen/pencil
 Notebooks /exercise books
Data Collection Techniques
 Pretesting
 Questionnaires were administered to mothers of preterm infants
included in the study. Those who could read and understand
answered the questionnaires themselves. Those who could not
read and understand the questions were guided through the
process by the interviewer.
 Sessions were carried out for various subjects on various days as
to get the targeted number of respondents.
 Data was also gathered through participatory observation of daily
routine procedures/activities in the unit.

 Statistical Package for Social Sciences (SPSS) software was used

in the analysis of the data.
Mothers Knowledge on the Cause of their Current Preterm Births

Cumulative
Causes Frequency Percent Percent
fetal abnormality 1 2.5 2.5
multiple gestation 1 2.5 5.0
medical conditions
15 37.5 42.5
in mother
premature rupture
19 47.5 90.0
of membranes
others (enema,
strenuous 4 10.0 100.0
activities, etc.)
Total 40 100.0
 Feelings of Mothers about Baby's Admission to MBU

Cumulative
Feelings Frequency Percent Percent
Scared 9 22.5 22.5
mixed
19 47.5 70.0
feelings
Guilty 2 5.0 75.0
Lonely 2 5.0 80.0
Sad 8 20.0 100.0
Total 40 100.0
 Time Spent by Mother and Baby Together in a Day

Cumulative
Time Frame Frequency Percent Percent
3-5 hours 1 2.5 2.5

5-7 hours 39 97.5 100.0

Total 40 100.0
 Other Activities Mothers do for Babies on Admission

20

15

Frequency
10
17 17

1
0
changing diapers changing diapers and changing diapers and changing diapers,
holding baby skin to skin cleaning babies, holding
cleaning babies
baby skin to skin
Activities
Relationship between Mother and Baby at the Time of Data Collection

Cumulative
Relationship Frequency Percent Percent
Withdrawn 1 2.5 2.5
Close 37 92.5 95.0
Incompetent 1 2.5 97.5
Helpless 1 2.5 100.0
Total 40 100.0
 Mothers Satisfaction with Information Provided by Healthcare
Providers

60

50

40

Percentages30
55.0%
45.0%
20

10

0
no yes
Mothers’ satisfaction
 Mothers Feelings about NICU Environment

Cumulative
Feelings Frequency Percent Percent
Scared 14 35.0 35.0
Conducive for
neonatal care 26 65.0 100.0

Total 40 100.0
• The study by Kennel and Klaus (1998) revealed that mothers with
more access to their babies in the hospital developed better rapport
with their infants, held them more comfortably, and smiled and
talked back to them more often.

• Majority (92.5%) of the mothers felt close to their babies and 90%
of them were comfortable relating to their babies.

• Four (10%) of the mothers were not comfortable relating to their

babies because of the equipment that was connected to them
(babies). These hindered them (mothers) from performing a range
of activities, such as holding babies in their bosom, cradling their
babies in their laps, etc.
• Eighteen (45%) of the mothers in this study practiced skin-to-skin
contact with their babies. These mothers displayed feelings of
confidence, competence, satisfaction and comfort. Such feelings gave
them a positive attitude towards the care of their babies.

• Skin-to-Skin Contact restores the unique mother-infant bond following

the sudden separation during the birth experience particularly in
premature births (Kirsten, Bergman, & Hann, 2001).

• Pictures and posters on KMC had been pasted on the unit. Mothers had
been well educated on KMC and its benefits for both mother and baby.

• However its practice was not very common. Reasons given were that the
babies’ conditions and equipment connected to them would not permit
mothers to practice KMC.
• Inadequate information provided by the healthcare team to the
mothers during such periods of emotional disturbances may
increase the anxiety and fears of the mothers. Twenty-two
(55%) of the mothers for this study were not satisfied with the
information provided by the healthcare team on the condition
of their babies. According to Mok and Leung (2006) mothers
of preterm infants desire more information and supportive
communication. Most parents do not want to have extensive
and complex explanation. Parents just want to be informed and
be able to ask questions, which make them feel included
(Gordin and Johnson, 1999).
• Fourteen (35%) of the mothers for this study said they were
scared of the MBU. Several studies by Shields, Kristensson-
Hallstrom, O'Callaghan (2003), Bass (1991) and Miles (1989)
showed that the environment at the NICU is experienced as a
stressor for parents of preterm infants, supporting the above
finding of this study. However, majority (65%) of the mothers
who participated in this study did not talk much about the high
technology environment at the MBU but saw the technology
as important for giving the infants the best care as possible.
 The study, “Effects of Preterm Birth on Bonding: A Study at KATH MBU”,
revealed the following;
 Admission of a preterm infant into the MBU has no direct negative effect on the
bonding process.
 Many mothers attributed the cause of their preterm delivery to physiological
processes and, as such, did not blame themselves.
 There were social support systems within the unit (relationships between
mothers and the healthcare team and that among mothers) which helped to allay
anxiety in mothers.
 Mothers spent between 5 – 7 hours with their babies in a day within which they
breastfed and performed other activities for them. Mothers testified that the time
they spent with their babies was enough for them.
 Fathers were not directly involved in the care of their babies except payment of
hospital bills and other expenses.
 Kangaroo mother care which was practiced by minority (45%) of the mothers
increased their confidence and competence in caring for their babies.
 Many mothers were not satisfied with the information provided to them by the
healthcare team about the condition of their babies.
 Fathers should be assisted to be actively involved in the care of their preterm
babies. Infection prevention measures such as the use of sterile gowns, washing
of hands before touching babies, etc. should be put in place so that fathers can
hold and perform other activities for their babies whenever they Fathers should
be assisted to be actively involved in the care of their preterm babies. Infection
prevention measures such as the use of sterile visit.
 Photographs of some preterm babies that have ever been on admission, at birth
and after some years of discharge should be pasted in the unit. This would give
new preterm parents the assurance that their babies would survive no matter
their condition as at the time of admission.
 There should be measures to promote the effective implementation of kangaroo
mother care. One of such measures is that a KMC unit should be established so
that babies that are about to be discharged can spend not less than 24hours with
their mothers there. KMC would then be practiced under the supervision of
nurses and other healthcare professionals.
 Parents just want to be informed and be able to ask questions, which make
them feel included (Gordin and Johnson, 1999). Therefore, information on
condition of babies should be explained in simple and clear terms to mothers
and they should also be encouraged to ask questions.
References
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Furthering the Understanding and Measurements of Neurodevelopmental Competence in Preterm and
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Interaction, Karolinska Institute, Stockholm.
• Bass L.S. (1991). What do Parents need when their Infant is a Patient in the NICU? Neonatal Network
10 (4) pp. 25–33
• Eckerman CO, Oehler JM, Medvin MB, Hannan TE (1994). Premature Newborns as Social Partners
before Term Age. In: Kleberg A (2006). Promoting Preterm Infants’ Development and Mother Child
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