Albert Einstein, Sir Issac Newton, Sir Sidney Poitier and Anna Pavlova all have something in common – they were all born prematurely and all achieved greatness in their own right. With World Prematurity Day (November 17) approaching, Dr Christopher Barnes, Senior Lecturer in Psychology, discusses the impact of having a baby born prematurely on parents and their babies, and the ways in which they can be supported during hospitalisation.
Around one in thirteen babies in the UK are born prematurely (i.e. before 37 weeks gestation age) so that is approximately 60,000 premature births each year. Parents of babies born prematurely have to deal with a multitude of factors that begins with the unexpected and early delivery process, and the environment of the neonatal unit; the technical equipment that surrounds the baby, procedures carried out on their baby (e.g. heel prick), the death and suffering of other babies, and the many sounds from monitoring equipment. Parents will often share rooms too where they will cope with the reactions and emotions of other parents that may affect their own emotional state and understanding of their own baby’s condition.
What is the impact on the baby?
The severity of their baby’s illness, treatments they are undergoing and the way the baby looks can all differ significantly and not just compared to other prematurely born babies but with those born at term too. The typical demeanour of a premature baby is one of low alertness and fewer periods of wakefulness, they are less active and responsive to social stimulation during the neonatal period and, when they do respond to stimulation, they will often emit less clear behavioural signals that is likely to make interaction with parents more difficult. All of these factors will naturally vary from situation to situation but will ultimately make parenting a more complex process.
Large cohort studies, such as EPICure and EPICure 2, were designed to investigate survival and later health status (e.g. disability) of extremely premature babies (<27 weeks Gestation) and show that, although the number of births prior to 27 weeks gestation is relatively small (1%), the enhancements in medical technologies mean than more babies are surviving and are a poorer prognosis for life. Also, some of the results show that while birthweight and socioeconomic status are highly influential factors on later development, the earlier a baby is born, and particularly in extremely premature babies, the higher the risk is to survival, long-term disability, and poorer motor and cognitive functioning.
Supporting parents and their prematurely born babies during hospitalisation
Most professionals agree that touch is crucial for the general well-being and development of the neonate. While there has been some debate about the type of touch that is the most appropriate for hospitalised preterm neonates, extra supplemental touch has been used in a variety of ways to aid in the babies’ development, to enhance parenting and facilitate the relationship with their baby. There are several different types of tactile interventions that have been developed during the last 40 years for use with premature babies and these include Kangaroo care, baby massage and TAC-TIC.
The Kangaroo method originated in part from the work of paediatrician Dr Edgar Rey-Sanabria who demonstrated marked increases in the survival rates of babies who were born in Columbia and kept under the clothing and in skin-to-skin contact with their mothers in the absence of incubators.
Kangaroo Care, recommended by the National Health Service, is embedded within clinical guidelines (NICE), promoted by the National Childbirth Trust, UNICEF, Royal College of Midwives and the World Health Organisation, as a method of skin-to-skin contact. It is the single most accepted and promoted form of touch that parents can use during hospital – dependent upon the health status of the baby – and has been adopted worldwide. It is easy to see why, and this is because many of the reported benefits of Kangaroo care include; stabilisation of heart rate, increased oxygen levels, increased weight gain, and enhanced sleeping patterns. The benefits to the mother are also well documented and include; increased breastfeeding rates and durations, reduced anxiety, greater parenting confidence and maternal-infant bonding.
Unlike Kangaroo Care, baby massage is less typical or a standard part of hospital care within the UK, and has predominantly been used for research purposes with those born prematurely. This is perhaps unsurprising since actively touching a baby that is medically fragile may be more prone to problems or adverse reactions. Nevertheless, benefits have been reported to be weight gain, hospital stay for the babies and mother–infant interaction, and attachment.
However, not all reviews provide support on the effectiveness of massage to promote infant physical and mental health in low-risk population samples and the evidence that massage for hospitalised premature newborns is of benefit for developmental outcomes is unclear.
TAC-TIC (Touching and Caressing-Tender in Caring)
TAC-TIC involves touching the newborn in a systematic way – following a cephalocaudal pattern (from head to toe) – and became the first method of gentle fingertip or palm stroking to be designed especially for preterm neonates in intensive care.
The fundamental principles of TAC-TIC suggest that the baby should only be lightly touched in contrast to massage with each stroke carried out at the same speed while maintaining a balance between alerting and soothing movements. The health outcomes from receiving TAC-TIC are many and varied but, over the past two and a half decades, TAC-TIC has been used with those infants who are most at risk and who require oxygen and mechanical ventilation. Over this time period, several important benefits have been identified in relation to the physiological, immunological and behavioural processes of the premature baby.
However, some of my more recent research has demonstrated benefits to parents’ belief in their ability to parent a premature baby (parental self-efficacy), as-well-as parental self-esteem and parent-to-infant attachment. This is important because we know from our other related work that parental self-efficacy is one of the strongest predictors of quality of life in parents who have a child with a food allergy.
The experience of having a premature baby
We know that the process of having a premature baby is a very different experience in contrast to parents whose baby is born at term. There is great variability in the way in which parents’ experience this process and it is the result of factors such as birth and delivery, the neonatal environment, the baby’s health status, and the level of social support available to parents. All of these factors combined affect parents in different ways and mean that some may adapt better than others.
Extra supplemental touch has been, and continues to be, used as a way to enhance newborn development, parental psychological outcomes and involve parents in the early parenting process – a process that some may feel far removed from. Although not all types of touch have been adopted as part of standard care, parents may still use them to facilitate their relationship with their newborn. Obviously, receiving touch in these ways needs to be carefully managed in collaboration with professionals who work daily with these babies, in order to be sensitive to their needs and vulnerabilities. However, the benefits of receiving touch mean it has the potential to enhance the lives and outcomes of those parents and newborns affected by prematurity.